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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 1.5 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 AstraZeneca; Biocept, Inc; Foundation Medicine, Inc; Genomic Health; Guardant Health; and Novartis Pharmaceuticals Corporation.

Community Practice Connections: Precision Medicine Through Plasma: Using Liquid Biopsies in Contemporary Oncology Care


Release Date: January 31, 2018
Expiration Date: January 31, 2019
Media: Internet - based

 

Activity Overview

Successful patient selection and implementation of tumor interrogation methods, including such emerging technologies as liquid biopsies, are essential to providing timely, accurate characterization of different types of solid tumors, which can have a tremendous influence on treatment selection, and, ultimately, patient outcomes. Precision Medicine Through Plasma: Using Liquid Biopsies in Contemporary Oncology Care is being launched to address the rapidly evolving science and associated therapeutic developments resulting from the emergence of such novel testing strategies as liquid biopsies. In this half-day symposium, key experts in lung, breast, and gastrointestinal malignancies will provide an overview of the latest clinical data on liquid biopsies, followed by detailed case discussions with a multidisciplinary faculty.

Acknowledgement of Commercial Support

This activity is supported by educational grants from AstraZeneca; Biocept, Inc; Foundation Medicine, Inc; Genomic Health; Guardant Health; and Novartis Pharmaceuticals Corporation.

CME/CE Activity Table of Contents

  • Expert Perspective on Liquid Biopsy
  • Expert Perspective on Liquid Biopsy in Lung Cancer
  • Expert Perspective on Liquid Biopsy in Breast Cancer
  • Expert Perspective on Liquid Biopsy in Gastrointestinal Cancer

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 intended for medical oncologists, pathologists, and fellows who treat patients with cancer. 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:

  • Compare the relative strengths and limitations of liquid biopsy against those of conventional tissue biopsy
  • Identify the scientific foundations of liquid biopsy technology
  • Contrast available and emerging testing technologies with respect to sensitivity, specificity, and clinical applications for patients with cancer
  • Appraise clinical evidence pertaining to specific testing modalities that may help to individualize treatment protocols for patients with cancer

Faculty, Staff, and Planners' Disclosures

Chair

Benjamin Levy, MD
Clinical Director of Medical Oncology
Johns Hopkins Sidney Kimmel Cancer Center
Sibley Memorial Hospital
Washington, DC
 

Disclosure: Consultant: Genentech, Eli Lilly, AstraZeneca, Celgene, Bristol-Myers Squibb, Merck

Faculty

Ryan B. Corcoran, MD, PhD
Director, Gastrointestinal Cancer Center Program
Massachusetts General Hospital Cancer Center
Boston, MA
 
 

Disclosure: Consultant: Genentech, Merrimack, Taiho, Avidity NanoMedicines, Astex, Roche, Bristol-Myers Squibb, FogPharma, Loxo Oncology, Amgen

Geoffrey R. Oxnard, MD
Associate Professor of Medicine
Harvard Medical School
Dana-Farber Cancer Institute
Boston, MA
 

Disclosure: Consultant: AstraZeneca, Takeda, Inivata, DropWorks; Other: Honoraria from Sysmex, Guardant Health

Heather A. Parsons, MD, MPH
Instructor in Medicine
Harvard Medical School
Dana-Farber Cancer Institute
Boston, MA
 

Disclosure: No relevant financial relationships with commercial interests to disclose

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 focuses on the scientific foundations of liquid biopsy technology and a comparison of the relative strengths and limitations of liquid biopsy against those of conventional tissue biopsy as well as their application in non-small cell lung cancer (NSCLC). Below are some highlights from the Community Practice ConnectionsTM Live Video featuring Drs. Levy and Oxnard.
  • One emerging approach to molecular characterization of tumors involves “liquid biopsy”—the use of surrogate sources of DNA, such as blood, serum, and plasma samples, which often contain circulating tumor DNA (ctDNA) or circulating-free tumor cells to provide a snapshot of tumor heterogeneity.
  • Hear Benjamin P. Levy, MD, from Johns Hopkins Sidney Kimmel Cancer Center, review some available and emerging testing technologies, and clarify how they compare with respect to sensitivity, specificity, and clinical applications for patients with cancer:
  • Listen to Geoffrey R. Oxnard, MD, from Dana-Farber Cancer Institute, provide expert commentary on the role of liquid biopsies in cancer, when they might be preferable over conventional biopsies, when conventional biopsies are preferred, and whether there is a difference. He also explained how he recommends clinician pick a plasma genotyping assay and which testing approach would be the optimal first approach to detecting the EGFR T790M mutation upon acquired resistance,
  • Potential advantages over standard tissue genotyping include more rapid turnaround time, the lack of need of tissue for sampling, avoiding failed biopsies, eliminating sample bias, and minimizing the risks associated with conventional biopsies.
  • Research has focused on EGFR mutations, as well as other target genes for liquid biopsies in NSCLC, including:
  • KRAS, involved in secondary resistance to erlotinib and gefitinib,  
  • ROS1, a relatively infrequent mutation that is sensitive to crizotinib,
  • ALK, a mutation that is sensitive to ALK inhibitorsand 
  • PD-L1, a biomarker that, when overexpressed, is associated with sensitivity to certain immunotherapies.
  • In the current era of sequential therapy, liquid biopsy may have considerable utility for rapidly directing the use of new targeted therapies for acquired resistance in advanced NSCLC.
PER Pulse Recap (2 of 3)

This second of 3 PER Pulse™ Recaps focuses on impact of liquid biopsy on breast cancer management, from initial detection through resistant metastatic disease and perspectives on the future. Below are some highlights from the Community Practice ConnectionsTM Live Video featuring Dr. Parsons.
  • In this era of personalized medicine, a simple blood sample can offer the opportunity for a real-time assessment of the complexity of the disease in an individual patient, identifying mechanisms of resistance that can be conquered by selected therapies and translated into a decision-making tool for patients.
  • Listen to Heather A. Parsons, MD, MPH, from Dana-Farber Cancer Institute, provide an overview of the established biomarkers in breast cancer, portray how circulating tumor cells (CTCs) are prognostic in breast cancer and consider whether they lack sensitivity, describe the data and current status of the use of circulating tumor DNA (ctDNA) in breast cancer:
  • Using current treatment models for breast cancer, many patients remain overtreated or others, treatment is still not adequate. A tool to detect in real-time the presence or absence of micrometastatic disease in patients with breast cancer could revolutionize treatment for these patients. The challenge is that in order for a tool to be clinically useful, it needs to be extremely sensitive to rule out even very-low levels of micrometastatic disease.
  • Findings from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) show the efficacy of tamoxifen in the adjuvant setting versus metastatic setting, and highlight the potential to eliminate minimal residual disease (MRD). In early breast cancer, mutation tracking in ctDNA has been shown to predict risk of relapse and that single mutation tracking is exceptionally specific.
  • The use of ctDNA in early-stage breast cancer is promising. This ctDNA detection of MRD is highly specific, but the sensitivity needs improvement. Minimal residual disease detection has the potential to change practice, but validation studies are needed to add to the evidence base. 
Identifying patients with MRD could provide several advantages, including the delivery of new therapies to patients most in need, reduction of overtreatment of early-stage breast cancer, and the determination of whether we can cure patients with metastatic MRD.

PER Pulse Recap (3 of 3)

This third of 3 PER Pulse™ Recaps focuses on impact of liquid biopsy on gastrointestinal (GI) cancer management, including concordance of tissue and plasma biopsies in GI cancers, identification of recurrence by detecting postsurgical residual disease. Below are some highlights from the Community Practice ConnectionsTM Live Video featuring Dr. Corcoran.
  • New molecular profiling strategies for GI malignancies continue to gain support. Biomarkers that are currently used include mutated BRAF, mutated KRAS, microsatellite instability, and the Oncotype DX Colon Cancer Assay.
    • The majority of evidence for these and emerging options has been generated through retrospective studies. 
  • A recent prospective investigation of patients with KRAS wild-type metastatic colorectal cancer (mCRC) who received a FOLFIRI-cetuximab treatment regimen supported the usefulness of liquid biopsy for monitoring of patients with mCRC. The study used a BEAMing technique to assess for KRAS, NRAS, PIK3CA, and BRAF cell-free mutations, and yielded several interesting findings, including a correlation between continued wild-type circulating status and prolonged response. Rapid clinical deterioration was noted with abrupt increases in mutated DNA.
  • Hear Ryan B. Corcoran, MD, PhD, from Massachusetts General Hospital Cancer Center:
    • Review how various mechanisms can promote resistance in different patients and  in the same patient,
    • Explain whether single-lesion biopsies always capture heterogeneity of resistance, what the implications are, and how liquid biopsy can aid clinical decision making in overcoming heterogeneity of resistance,
    • Delineate how liquid biopsy might offer the ability to monitor emergence of resistance mechanisms in real-time and adjust therapy accordingly,
    • Describe the implications of subclinical residual disease, which patients are likely to recur, and strategies employed for the detection of residual disease, and
    • Appraise the potential applications of precision medicine through plasma liquid biopsy in GI cancers, and determine whether these efforts can be integrated into clinical care with the potential to transform adjuvant therapy: 
  • Liquid biopsy may permit detection of microscopic residual disease post-surgery, enabling precision therapy approaches to increase cure, allow us to bring our most innovative therapies to bear for GI patients with subclinical residual disease post-surgery to salvage cure, and ultimately, may allow screening and early detection in asymptomatic GI individuals, when these patients are curable. 
For additional expert commentary about these topics and others, visit www.gotoper.com to access more resources from the Community Practice ConnectionsTM - Precision Medicine Through Plasma: Using Liquid Biopsies in Contemporary Oncology Care








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