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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 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.

Resources

PER Pulse™ Recaps highlight key elements of the Oncology Best Practice™: Choosing Therapies for Patients with EGFR-mutant Lung Cancers: More Options... More Decisions... Better Outcomes online CME activity.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

Community Practice Connections™: Oncology Best Practice™: Choosing Therapies for Patients with EGFR-mutant Lung Cancers: More Options... More Decisions... Better Outcomes

Release Date: April 27, 2017
Expiration Date: April 27, 2018
Media: Internet - based

 

Activity Overview

Community Practice Connections™: Oncology Best Practice™: Choosing Therapies for Patients with EGFR-mutant Lung Cancers: More Options... More Decisions... Better Outcomes features case-based discussion of state-of-the-art therapy for patients with EGFR mutation-positive, non–small cell lung cancers (NSCLCs) through multiple lines of therapy. Interactive clinical vignettes are followed by short video interviews with leading lung cancer experts and short summaries of clinical data related to these issues. The video interviews address decision points in the clinical vignettes, including testing, treatment, and brain metastases, as well as questions commonly faced in the community oncology practice setting by physicians engaged in the care of patients with NSCLCs and EGFR mutations.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

CME/CE Activity Table of Contents

  • First-Line Therapy in EGFR Mutation-Positive Lung Cancer
  • Biopsy for Acquired Resistance
  • Leptomeningeal Disease
  • Second-Line Therapy
  • Subsequent Therapy

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 video files/content until you finish the presentation.
  • At the end of the activity, educational content/video 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 who treat patients with lung cancers. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare 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:

  • Detail evidence that underlies the application of optimized front-line strategies to manage EGFR-mutated advanced NSCLC
  • Describe methods to optimize EGFR subtyping and emerging technologies that can practically facilitate tumor testing, as well as overcome inherent challenges to optimized testing in community settings where advanced NSCLC is managed
  • Explain how to optimize the timing of clinical interventions in relapsed advanced NSCLC settings and the trial evidence that informs decision-making to treat patients with EGFR-TKI resistance
  • Address treatment-related toxicities and methods to optimize the management of central nervous system metastases in the care of patients with advanced NSCLC

Faculty, Staff, and Planners' Disclosures

Faculty

Mark G. Kris, MD
Attending Physician, Thoracic Oncology Service
Memorial Sloan Kettering Cancer Center
New York, NY
 
 

Disclosure: PUMA, Pfizer, Genentech; Consultant: AstraZeneca, ARIAD, Roche/Genentech, Array

Alexander Drilon, MD
Clinical Director, Developmental Therapeutics
Assistant Attending Physician
Thoracic Oncology Service
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosure: Other Support: Genentech, Ariad, Ignyta, LOXO, Blueprint

Balazs Halmos, MD
Professor of Clinical Medicine
Section Chief Thoracic Oncology and Director
Clinical Cancer Genomics
Albert Einstein College of Medicine
Einstein Montefiore Cancer Center

Disclosure: Grant/Research Support: Mirati, Eli Lilly, Merck, Boehringer Ingelheim; Consultant: FoundationOne, AstraZeneca, Boehringer Ingelheim, Genentech, Pfizer, Eli Lilly.

Helena Yu, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
New York, NY
 
 

Disclosure: Consultant: Eli Lilly, Boehringer Ingelheim; Grant/Research Support: (paid to institution) Astellas, AstraZeneca, Eli Lilly.

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 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®.

PER Pulse™ Recap


1 of 3
PER Pulse™ Recap

First-Line Treatment of Patients with EGFR-Mutant Lung Cancers

Featuring key lung cancer experts Alexander Drilon, MD; Balazs Halmos, MD; Mark G. Kris, MD; and Helena A. Yu, MD, this first of 3 PER Pulse™ Recaps from Oncology Best Practice™: Choosing Therapies for Patients with EGFR-Mutant Lung Cancers: More Options... More Decisions... Better Outcomes focuses on frontline therapy for patients with non–small cell lung cancers (NSCLCs) and mutations in the epidermal growth factor receptor (EGFR) gene:

  • Currently, the standard approach for patients with EGFR mutation-positive NSCLCs is single-agent therapy with a first- or second-generation EGFR tyrosine kinase inhibitor (TKI), such as erlotinib, afatinib, or gefitinib. Although there are few data on direct comparisons among these 3 EGFR TKIs, the phase 2b LUX-Lung 7 trial indicated a benefit in progression-free survival (PFS) with afatinib compared with gefitinib. No difference in overall survival was noted between the 2 TKIs, however, and there was also an increase in certain toxicities, including diarrhea and rash, with afatinib.
  • Potential future first-line approaches include the addition of bevacizumab to erlotinib and the use of third-generation EGFR TKIs. Early-phase data suggest improved PFS with both of these approaches compared with the current standard of care, although randomized trials are ongoing to confirm these results.

For additional commentary about this topic and others, visit www.gotoper.com.


2 of 3
PER Pulse™ Recap

Challenging Situations: Biopsy for Acquired Resistance and Managing Leptomeningeal Disease

Featuring key lung cancer experts Alexander Drilon, MD; Balazs Halmos, MD; Mark G. Kris, MD; and Helena A. Yu, MD, this second of 3 PER Pulse™ Recaps from Oncology Best Practice™: Choosing Therapies for Patients with EGFR-Mutant Lung Cancers: More Options... More Decisions... Better Outcomes focuses on the challenges that patients with non–small cell lung cancers (NSCLCs) and mutations in the epidermal growth factor receptor (EGFR) gene face from acquired resistance and leptomeningeal disease:

  • When acquired resistance occurs during therapy with an EGFR tyrosine kinase inhibitor (TKI), the faculty in this activity mention the importance of first assessing the need for the patient to change therapy. If there is limited progression or oligoprogression, local therapy may be appropriate. However, if progression is more extensive, then a change in therapy is likely required and molecular testing needed. Approximately 50% to 60% of patients experiencing acquired resistance will have the T790M-resistance mutation, for which the third-generation EGFR TKI osimertinib is indicated.
  • In the case of central nervous system (CNS) metastases, it is informative to know if the CNS relapse is due to emergence of the T790M-resistance mutation or pharmacologic failure of the EGFR TKI to penetrate the CNS. The expert recommendation is therefore to request assistance from a specialist, such as a neuro-oncologist or a neurologist, who can facilitate a lumbar puncture that can be used to determine if the CNS disease is positive for T790M. If T790M is detected, data from the BLOOM trial indicate a potential role for osimertinib. If the CNS progression is T790M-negative, however, chemotherapy with or without bevacizumab is a reasonable option.

For additional commentary about this topic and others, visit www.gotoper.com.


3 of 3
PER Pulse™ Recap

Second-Line and Subsequent Therapy

Featuring key lung cancer experts Alexander Drilon, MD; Balazs Halmos, MD; Mark G. Kris, MD; and Helena A. Yu, MD, this third of 3 PER Pulse™ Recaps from the Oncology Best Practice™: Choosing Therapies for Patients with EGFR-Mutant Lung Cancers: More Options... More Decisions... Better Outcomes focuses on second-line and subsequent lines of therapy for patients with non–small cell lung cancers (NSCLCs) and mutations in the epidermal growth factor receptor (EGFR) gene:

  • In the case of a patient with T790M-positive progression on a first-line EGFR tyrosine kinase inhibitor (TKI), the expert recommendation is to first assess the locations of progression. Progressive disease at multiple sites would warrant changing therapy to osimertinib, while in the case of more limited progression, local therapy and continuation of the original TKI might be appropriate.
  • For patients who progress during therapy with osimertinib and a subsequent platinum doublet, there are few definitive clinical data. However, subset analyses of phase III trials suggest that patients with EGFR mutation-positive NSCLCs do not benefit from immunotherapy compared with docetaxel. Therefore, experts would still favor docetaxel-based therapy, with or without ramucirumab, following a platinum doublet. Afatinib/cetuximab is another potential option. Additionally, further molecular testing may be carried out, as other actionable oncogenic drivers may be identified.

For additional commentary about this topic and others, visit www.gotoper.com.







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