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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 1.0 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 1.0 Contact Hours.

Acknowledgement of Commercial Support

This activity is supported by an educational grant/educational grants from Foundation Medicine, Inc.

Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care

Release Date: November 30, 2017
Expiration Date: November 30, 2018
Media: Internet - based

 

Activity Overview

This online activity, which includes expert opinions from 2 faculty members, discusses the optimization of diagnosis, treatment selection, and management of patients with cancer using emerging tumor-testing technologies. It covers such exciting topics as liquid biopsies, next-generation sequencing, and tumor mutation burden. This activity also explores what tumor-testing technologies are expected in the future and which technologies can be used to improve the care of patients with cancer right now.

Acknowledgement of Commercial Support

This activity is supported by an educational grant/educational grants from Foundation Medicine, Inc.

CME/CE Activity Table of Contents

  • Module 1. Advantages and Challenges of Next-Generation Sequencing
  • Module 2. Gaining Familiarity With Plasma (Liquid) Biopsies
  • Module 3. Evolving Use of Tumor Mutation Burden
  • Module 4. Looking Forward With Tumor-Testing Technologies

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 program is primarily directed toward medical oncologists who treat patients with cancer. It has been developed to meet the needs of the “everyday oncologist” in community practice. Fellows, nurses, nurse practitioners, physician assistants, and other healthcare professionals involved in the treatment of cancer will also be invited to participate.

Learning Objectives

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

  • Analyze strategies for tumor testing in patients with cancer, including next-generation sequencing, liquid biopsies, comprehensive genomic profiling, hotspot analysis, and tissue biopsies
  • Implement best practices to individualize treatment of patients with cancer based on assessment of the tumor profile and patient characteristics
  • Explain the role of multidisciplinary teams in facilitation and implementation of novel tumor-testing technologies in clinical practice settings
  • Integrate office-based systems and guideline use to overcome barriers to personalized medicine and increase cancer screening in the community setting

Faculty, Staff, and Planners' Disclosures

Faculty

Joseph A. Sparano, MD
Professor, Department of Medicine (Oncology)
Professor, Department of Obstetrics & Gynecology and Women’s Health
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, NY


Disclosure: Grant/Research Support - Prescient, Deciphera; Consultant - Eli Lilly, Pfizer, Genentech, AstraZeneca; Stock/Shareholder - MetaStat, Inc.

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


Disclosure: Grant/Research Support - Merck, Astra-Zeneca/Medimmune. Pfizer. Novartis, Eli-Lilly. Mirati. Boehringer-lngelheim, BMS. Takeda. Consultant: Foundation One. Guardant Health. Genoptix. Eli-Lilly. Pfizer, Celgene. Astra-Zeneca. Boehringer-lngelheim. Novartis. Takeda

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 Oncology Best Practice™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care was a series of programs in which national cancer and genetic testing experts discussed the optimization of diagnosis, treatment selection, and management of patients with cancer using emerging tumor-testing technologies. Two of these renowned faculty members, Joseph A. Sparano, MD, and Balazs Halmos, MD, were interviewed, and their insights into the evolving use of novel tumor-testing technologies were provided in short video clips. These video clips were supplemented by supporting text expanding on these insights in an online Community Practice Connections™ CME activity.
 
This first of 3 PER Pulse™ Recaps reviews the advantages and challenges of next-generation sequencing (NGS). Below are some highlights from the Community Practice Connections™ featuring Drs. Sparano and Halmos:
 
  • Next-generation sequencing has a number of advantages over other molecular analysis techniques:
    • Ability to sequence hundreds or even thousands of genes, making it possible to discover mutations not widely found in the patient’s tumor type
    • Requirement for a low quantity of DNA or RNA
    • Ability to identify all 4 types of genomic alterations: base substitutions, insertions and deletions, copy number alterations, and rearrangements
    • Reduced per-gene cost compared with other sequencing techniques
  • Some challenges to the widespread use of NGS do exist. Validation of this approach is still needed, with a number of performance parameters yet to be established, including analytical sensitivity, analytical specificity, accuracy, precision, limit of detection, sequencing depth, and allelic frequency cutoffs. In addition, reimbursement of NGS remains a challenge, as policies are needed to match the complexities of NGS testing.
  • However, the clinical utility of NGS is promising, as shown by a recent study in which one-quarter of patients with metastatic cancer whose tumors were tested by NGS had their therapy changed to a targeted approach personalized to their tumor profile on the basis of the NGS results. This demonstrates that NGS has the potential to change treatment, and potentially positively impact clinical outcomes.
 
For additional commentary about this topic and the Oncology Best Practice™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care activity, please visit www.gotoper.com.
 

 

PER Pulse Recap (2 of 3)
 
 
The live continuing medical education (CME) activity Oncology Best Practice™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care was a series of programs in which national cancer and genetic testing experts discussed the optimization of diagnosis, treatment selection, and management of patients with cancer using emerging tumor-testing technologies. Two of these renowned faculty members, Joseph A. Sparano, MD, and Balazs Halmos, MD, were interviewed, and their insights into the evolving use of novel tumor-testing technologies were provided in short video clips. These video clips were supplemented by supporting text expanding on these insights in an online Community Practice Connections™ CME activity.
 
This second of 3 PER Pulse™ Recaps discusses the clinical utility of plasma (liquid) biopsies.
Below are some highlights from the Community Practice Connections™ featuring Drs. Sparano and Halmos:
  • Liquid biopsies analyze either circulating tumor cells (CTCs) or circulating cell-free tumor DNA (ctDNA) in the blood of patients with cancer. Although both are considered liquid biopsies, they represent distinct approaches for cancer assessment:
    • Circulating tumor cells are released from the primary or metastatic tumor into the bloodstream, and the number of CTCs in a liquid biopsy are quantified.
    • Circulating cell-free tumor DNA arises from tumor DNA shed from primary tumors, CTCs, and metastatic sites into the bloodstream, and this cell-free DNA can be analyzed for genomic alterations, just as tissue samples are analyzed.
  • Circulating tumor cell counts can be used to identify those patients at high risk of certain types of cancer, allowing them to undergo additional surveillance techniques.
  • Both types of liquid biopsies have shown promise in providing prognostic information, with the presence of ctDNA in the weeks following colorectal cancer surgery showing a strong correlation with risk of relapse and CTC counts showing an inverse correlation with overall survival for patients with non-small cell lung cancer.
  • Both CTCs and ctDNA are also well-suited for real-time serial monitoring of cancer because they have short half-lives in blood (1-2 hours for CTCs, 16 minutes for ctDNA).
  • According to Dr. Sparano, liquid biopsies are replacing tissue biopsies under certain clinical circumstances, and have demonstrated both analytic validity and clinical validity.
 
For additional commentary about this topic and the Oncology Best Practice™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care activity, please visit www.gotoper.com.


PER Pulse Recap(3 of 3)
 
 
The live continuing medical education (CME) activity Oncology Best Practice™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care was a series of programs in which national cancer and genetic testing experts discussed the optimization of diagnosis, treatment selection, and management of patients with cancer using emerging tumor-testing technologies. Two of these renowned faculty members, Joseph A. Sparano, MD, and Balazs Halmos, MD, were interviewed, and their insights into the evolving use of novel tumor-testing technologies were provided in short video clips. These video clips were supplemented by supporting text expanding on these insights in an online Community Practice Connections™ CME activity.
 
This third of 3 PER Pulse™ Recaps describes the emerging clinical utility of tumor mutation burden (TMB). Below are some highlights from the Community Practice Connections™ featuring Drs. Sparano and Halmos:
 
  • Tumor mutation burden is defined as the total number of nonsynonymous mutations per coding area of a tumor genome, and it varies both across individuals with cancer and across tumor types. Lung cancers, melanomas, and certain gastrointestinal cancers typically have high TMB, whereas pediatric cancers and certain hematologic malignancies typically have low TMB.
  • Cancers with high TMB are more likely to respond to immune checkpoint blockade with agents such as pembrolizumab, nivolumab, and atezolizumab. The immunogenicity associated with high TMB occurs because cancers accumulate somatic mutations, which result in the expression of neoantigens, which in turn elicit T-cell responses. Therefore, the higher number of neoantigens, the more likely the immune system can be effective against the tumor. Strong evidence exists supporting the emergence of TMB as a biomarker to predict who is most likely to receive benefit from immune checkpoint inhibitors:
    • In a melanoma study of immune checkpoint inhibition, patients receiving long-term benefit from ipilimumab or tremelimumab had significantly higher TMB than those receiving minimal or no benefit.
    • Similarly, in a study of non-small cell lung cancer (NSCLC), patients receiving durable clinical benefit from the PD-1 inhibitor pembrolizumab had significantly higher TMB than those with no durable benefit. Moreover, in CheckMate 026, a phase III NSCLC trial in which nivolumab failed to demonstrate a progression-free survival (PFS) or overall survival benefit compared with chemotherapy, nivolumab did demonstrate a PFS benefit in patients from this trial who had tumors with high TMB.
    • Finally, evidence showing the predictive ability of TMB comes from patients with tumors that are microsatellite-instability‒high (MSI-H). These tumors have impaired DNA mismatch repair, which correlates strongly with high TMB due to the accumulation of mutations. Clinical investigation of colorectal cancer and other tumor types demonstrated that patients with MSI-H tumors had more responses to pembrolizumab than did patients with microsatellite-stable disease, leading to FDA approval of pembrolizumab specifically in patients with any advanced solid tumors that are MSI-H.
 
For additional commentary about this topic and the Oncology Best Practice™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer Care activity, please visit www.gotoper.com.







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