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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.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

Community Practice Connections™: Working Group for Changing Standards in EGFR-Mutated Lung Cancers: Real-World Applications of the Evidence for Nurses


Release Date: June 29, 2018
Expiration Date: June 29, 2019
Media: Internet - based
 

Activity Overview

Community Practice Connections: Working Group for Changing Standards in EGFR-Mutated Lung Cancers: Real-World Applications of the Evidence for Nurses consists of a summary of clinical data on changing standards of care for patients with EGFR-mutated lung cancer, as well as a series of interactive clinical vignettes and short video interviews with leading healthcare experts in lung cancer. The video interviews address decision points in the clinical vignettes, as well as questions commonly faced in the community oncology practice setting.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

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 all attendees of the ONS 43rd Annual Congress, including nurses and other healthcare professionals with an interest in the treatment of lung cancer.

Learning Objectives

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

  • Explain optimal testing platforms to utilize that can inform clinical decision making in newly diagnosed and relapsed patients with advanced NSCLC
  • Apply clinical trial evidence to optimize the initial treatment of advanced EGFR mutation‒positive NSCLC
  • Determine key resistance mutations and strategies to address relapsed disease, and to optimally sequence approaches beyond disease progression in advanced NSCLC
  • Describe practical methods to proactively identify and mitigate the impact of treatment-related toxicities in the management of patients with advanced NSCLC
Program Co-Chairs

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

Disclosures: Consultant: AstraZeneca, Celgene, Merck, Eli Lilly, Genentech, Takeda

Rasheda Persinger, MSN, AGNP-C
Medical Oncology Nurse Practitioner
Sibley Memorial Hospital
Washington, DC
 
 

Disclosure: Speaker's Bureau: Guardant360

Faculty

Joshua Bauml, MD
Associate Professor
Department of Breast Medical Oncology
The University of Texas MD Anderson Cancer Center
Houston, TX
 

Disclosure: Grant Research Support: AstraZeneca, Pfizer, EMD Serono, GlaxoSmithKline, Genentech; Consultant: AstraZeneca, Pfizer

Ann Culkin, RN, OCN
Department of Nursing
Office of Azadeh Namakydoust, MD
Memorial Sloan Kettering Cancer Center
Middletown, NJ
 

Disclosure: No relevant financial relationships with commercial interests to disclose.

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

Disclosure: Consultant: AstraZeneca

Victoria Sherry, DNP, CRNP, AOCNP
Clinical Director, Developmental Therapeutics Clinic
Assistant Attending Physician, Thoracic Oncology Service
Memorial Sloan Kettering Cancer Center
New York, NY
 

Disclosure: No relevant financial relationships with commercial interests to disclose.

The staff of Physicians' Education Resource®, LLC 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 or nurse 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 Working Group for Changing Standards in EGFR-Mutated Lung Cancers: Real-World Applications of the Evidence for Nurses, which was held May 17, 2018, in Washington, DC, updated oncology nurses and other practitioners on recent advances in therapy and nursing strategies for patients with advanced non–small cell lung cancer (NSCLC) and activating mutations in the epidermal growth factor receptor (EGFR) gene. In addition, this program provided expert guidance on how to proactively mitigate and manage treatment-related toxicities. This first of 3 PER Pulse™ Recaps from this program focuses on approaches to molecular testing in patients with NSCLC.
  • A comprehensive guideline to molecular testing has received an update that was published in 2018. In addition to testing for genetic aberrations in EGFR and anaplastic lymphoma kinase (ALK) genes, additional molecular tests are recommended, including ROS1 and BRAF, as approved agents are available for these targets.
  • In patients with EGFR mutation-positive NSCLC who progress on a first- or second-generation EGFR inhibitor as initial therapy and require a new approach, testing for the T790M resistance mutation is the standard approach to determine eligibility for osimertinib. For patients who receive osimertinib as initial therapy, however, T790M does not appear to be a major mechanism of resistance, and institutional guidelines on testing and subsequent therapy should be consulted.
  • Waiting for the results of testing can be stressful, and experts have provided recommendations to minimize the negative effects of the waiting period. The patient’s psychological state should be assessed and the patient’s and their family’s concerns about delay of care while waiting for results should be addressed. Additionally, to minimize the possibility of complications, adequate tissue should be obtained for the test, and the tissue sample should be sent to pathology appropriately.

PER Pulse Recap (2 of 3)

This second of 3 PER Pulse™ Recaps from this program focuses on recent approvals and regulatory actions for first-line therapy of patients with EGFR mutation-positive NSCLC.
  • Erlotinib, afatinib, and gefitinib have been the standard first-line approach for patients with EGFR mutation-positive NSCLC. However, osimertinib received first-line approval in April 2018, based on the FLAURA trial. This study has demonstrated superior progression-free survival (PFS) with osimertinib compared with erlotinib or gefitinib; overall survival (OS) data are still maturing.
  • A second-generation EGFR inhibitor, dacomitinib, is currently under review for first-line therapy, with a decision expected by September 2018. This review is based on results of the ARCHER 1050 trial demonstrating improved PFS and OS with dacomitinib compared with gefitinib. However, there was a higher incidence of grade ≥3 adverse events in the dacomitinib arm, including dermatitis acneiform, diarrhea, and paronychia.
  • The most common sensitizing EGFR mutations are the exon 19 deletion and the L858R mutation in exon 21. For patients with less common activating mutations, including L861Q, G719X, and S768I, afatinib received approval in January 2018.

PER Pulse Recap (3 of 3)

This third of 3 PER Pulse™ Recaps from this program focuses on expert opinion on the mitigation and management rash and paronychia associated with EGFR inhibitors.
  • For rash, some expert faculty recommendations include the following:
    • Weekly evaluation for rash during the first 6 weeks of treatment
    • Regular assessment of oral adherence to treatment throughout the course of therapy
    • Counseling the patient to avoid sun exposure, to wash with tepid water because warm water can cause rashes to flare, and to use a moisturizer and sunscreen free of para-aminobenzoic acid
    • Use of steroids and antibiotics (following institutional guidelines)
  • To address paronychia, faculty advice includes the following steps:
    • Wearing comfortable shoes
    • Avoiding aggressive manicuring
    • Wearing gloves while cleaning
    • Use of topical steroids or tetracycline in the event of infection
    • Soaking to lessen discomfort, particularly if there is drainage or the nail is pulling away 
For additional commentary about this topic and the Working Group for Changing Standards in EGFR-Mutated Lung Cancers: Real-World Applications of the Evidence for Nurses symposium, please visit www.gotoper.com.







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