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.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from Merck & Co, Inc.

Community Practice Connections™: Melanoma Tumor Board: Matching Treatment to Patient

Release Date: August 30, 2019
Expiration Date: October 28, 2020
Media: Internet - based

Activity Overview

The management of melanoma has shifted in recent years, with improved understanding of signaling pathways and resistance mechanisms underlying the pathogenesis of metastatic melanoma. This has led to advances in the development of targeted therapies. These new approaches have given physicians the ability to target previously unreachable treatment goals to improve patient outcomes. Novel treatment strategies for advanced melanoma raise challenging questions, and uncertainty often arises regarding the best strategies for integrating new treatments into current treatment paradigms, in addition to concerns for the proactive management of treatment-related adverse events. The ability to evaluate efficacy of new therapies, manage adverse events, and implement biomarkers for selecting therapy is critical for making informed decisions and optimizing patient care. This educational activity is based on a live symposium held adjunct to the 2019 clinical oncology annual meeting in Chicago. Through a series of written passages and brief video interviews, expert faculty review the impact of clinical data on patient care, discuss clinical cases, and share forward-looking perspectives on the treatment of advanced melanoma.

Benefits of Participating

  • Hear expert perspectives and recommendations for treating stage III melanoma
  • Learn about the latest in biomarker development
  • Become more aware of managing adverse events s of immunotherapy
  • Get insights on sequencing strategies for advanced melanoma

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Merck & Co, Inc.

Instructions for This Activity and Receiving Credit

  • You will need to log in 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 audios/content until you finish the presentation.
  • At the end of the activity, “Educational Content/Audio” will be available for your reference.
  • In order to receive a CME Certificate, you 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.” You may immediately download a CME Certificate upon completion of these steps.

Target Audience

This educational program is directed toward medical oncologists, surgical oncologists, and radiation oncologists involved in the treatment and management of patients with melanoma. Fellows, nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of melanoma may also participate.

Learning Objectives

Upon successful completion of this educational activity, you should be better prepared to:

  • Assess recently reported clinical trial data for safety and efficacy of emerging therapies, novel combinations, and therapeutic sequencing strategies for melanoma treatment
  • Apply best practices to proactively identify and mitigate the impact of treatment-related toxicities in settings where patients with melanoma are managed
  • Discuss emerging data on the use of biomarkers to guide individualized care for patients with melanoma
  • Integrate emerging data on therapeutic sequencing options into the context of treatment for patients with melanoma

Faculty, Staff, and Planners’ Disclosures

Faculty

Jeffrey S. Weber
Jeffrey S. Weber, MD, PhD
Deputy Director
Laura and Isaac Perlmutter Cancer Center
Professor of Medicine
NYU Langone Medical Center
New York, NY

Disclosures: Grant/Research Support: Bristol-Myers Squibb, Merck, GlaxoSmithKline, Genentech, Astellas Pharma, Incyte, Roche, Novartis, NextCure; Consultant: Celldex, Ichor Medical Systems, BioND, Altor BioSciences, Bristol-Myers Squibb, Merck, Genentch, Roche, Amgen, AstraZeneca, GlaxoSmithKline, Daiichi Sankyo, AbbVie, Eisai, CytomX Therapeutics, Nektar, Novartis, Sellas, WindMIL, Takeda; Shareholder: Altor BioScience, BioND, CytomX Therapeutics, Protean BioDiagnostics; Honoraria: Bristol-Meyers Squibb, Merck, Genentch, AbbVie, AstraZeneca, Daiichi Sankyo, GlaxoSmithKline, Eisai, Altor BioScience, Amgen, Roche, Ichor Medical Systems, Celldex, CytomX Therapeutics, Nektar, Novartis, Sellas, WindMIL, Takeda, Protean BioDiagnostics; Travel/Accomodations: Bristol-Myers Squibb, GlaxoSmithKline, Daiichi Sankyo, Roche, Celldex, Amgen, Merck, AstraZeneca, Genetech, Novartis, WindMIL, Takeda.

Omid Hamid
Omid Hamid, MD
Chief of Research/Immuno-Oncology
Co-Director, Cutaneous Malignancy Program
The Angeles Clinic and Research Institute
Los Angeles, CA

Disclosures: Grant Research Support: Amgen, Arcus, Astellas, AstraZen¬eca, Bristol-Myers Squibb, Celldex, CytomX Therapeutics, Genentech, GlaxoSmithKline, Immunocore, Incyte, Iovance, Merck, Merck Serono, MedImmune, NextCure, Novartis, Parker Institute, Pfizer, Polynoma, Regeneron, Roche.

Ragini Kudchadkar
Ragini Kudchadkar, MD
Associate Professor, Department of Hematology and Medical Oncology
Emory University School of Medicine
Atlanta, GA

Disclosures: Grant Research Support: Merck, Bristol-Myers Squibb; Consultant: Bristol-Myers Squibb, Novartis, Array.

Mario Sznol
Mario Sznol, MD
Professor of Medicine (Medical Oncology)
Yale School of Medicine
Co-Director of Yale SPORE in Skin Cancer
Yale Cancer Center
New Haven, CT

Disclosures: Consultant: Genetech/Roche, Bristol-Myers Squibb, AstraZeneca/Medimmune, Novartis, Seattle Genetics, Nektar, Lilly, Biodesix, Modulate Therapeutics, NewLink Genetics, Molecular Partners, Innate Pharma, AbbVie, Immunocore, Genmab, Almac, Hinge, Allakos, Anaeropharma, Array; Scientific Advisory Board: Symphogen, Adaptimmune, Omniox, Lycera (no longer active), Pieris; Torque (consulting fees and stock options), Verseau.

The staff of Physicians' Education Resource®, LLC (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 activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME 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 activity is for continuing medical and nursing education purposes only and is not meant to substitute for the independent clinical judgment of a physician and nurse 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™ Recaps

1 of 3

Melanoma Tumor Board™: Matching Treatment to Patient is a continuing medical education–certified activity in which Jeffrey S. Weber, MD, PhD; Omid Hamid, MD; Ragini Kudchadkar, MD; and Mario Sznol, MD; discuss the best strategies for integrating new melanoma therapies into practice.

This online activity begins by exploring the evolution of melanoma therapy, focusing on melanoma staging changes, resistance to immunotherapy, immune-related adverse effects, and biomarkers in melanoma. Below are highlights of the topics covered during the activity.

  • Staging changes reflected in the eighth edition of the American Joint Committee on Cancer’s AJCC Cancer Staging Manual1
  • Key factors of primary and acquired resistance to immunotherapy2
  • Mitigating common and serious immune-related adverse effects3
  • Established and emerging biomarkers as predictors of response to immunotherapy4-6

“[A predictive biomarker is] going to be some combination of a tumor microenvironment marker and a host marker(s) that will provide an algorithm and a guide for someone to decide [whom] to treat and [whom] not to treat.”

—Jeffrey S. Weber, MD, PhD

References

  1. Amin MB, Edge S, Greene F, et al; eds. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2018.
  2. Jenkins RW, Barbie DA, Flaherty KT. Mechanisms of resistance to immune checkpoint inhibitors. Br J Cancer. 2018;118(1):9-16. doi: 10.1038/bjc.2017.434.
  3. Brahmer JR, Lacchetti C, Schneider BJ, et al; National Comprehensive Cancer Network. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018;36(17):1714-1768. doi: 10.1200/JCO.2017.77.6385.
  4. Samstein RM, Lee CH, Shoushtari AN, et al. Tumor mutational load predicts survival after immunotherapy across multiple cancer types. Nat Genet. 2019;51(2):202-206. doi: 10.1038/s41588-018-0312-8.
  5. Weber JS, Tang H, Hippeli L, et al. Serum IL-6 and CRP as prognostic factors in melanoma patients receiving single agent and combination checkpoint inhibition. J Clin Oncol. 2019;37(suppl 15; abstr 100). doi: 10.1200/JCO.2019.37.15_suppl.100.
  6. van Herpen CML, Agarwala SS, Hauschild A, et al. Biomarker results from a phase II study of MEK1/2 inhibitor binimetinib (MEK162) in patients with advanced NRAS- or BRAF-mutated melanoma. Oncotarget. 2019;10(19):1850-1859. doi: 10.18632/oncotarget.26753.

2 of 3

Melanoma Tumor Board™: Matching Treatment to Patient is a continuing medical education–certified activity in which Jeffrey S. Weber, MD, PhD; Omid Hamid, MD; Ragini Kudchadkar, MD; and Mario Sznol, MD; discuss the best strategies for integrating new melanoma therapies into practice.

This online activity features dialogues regarding data supporting clinical decisions for adjuvant therapy for stage III/IV melanoma. Below are highlights of the topics covered during the activity.

  • Impact of adjuvant therapy in treatment of melanoma: results of the CheckMate 238 study1
  • KEYNOTE-054 trial supporting the approval of pembrolizumab as adjuvant therapy2
  • Dabrafenib plus trametinib for resected stage III melanoma with BRAF V600 mutations based on COMBI-AD trial findings3
  • Importance of comprehensive genomic profiling for stage III melanoma
  • Controversy surrounding adjuvant therapy in stage IIIA melanoma
  • Immunotherapy options for stage IV BRAF wild-type melanoma

“In this population, we are quite unclear about the absolute benefit of giving early therapy in relation to the risks of toxicities for 1 year of adjuvant therapy. At that point, it is a mandated discussion with the patient about options, which includes surveillance.…”

—Omid Hamid, MD

References

  1. Weber J, Mandala M, Del Vecchio M, et al; CheckMate 238 Collaborators. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377(19):1824-1835. doi: 10.1056/NEJMoa1709030.
  2. Study of Pembrolizumab (MK-3475) Versus Placebo After Complete Resection of High-Risk Stage III Melanoma (MK-3475-054/1325-MG/KEYNOTE-054). Clinicaltrials.gov/ct2/show/NCT02362594. Updated February 12, 2019. Accessed August 2, 2019.
  3. Long GV, Hauschild A, Santinami M, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377(19):1813-1823. doi: 10.1056/NEJM0a1708539.

3 of 3

Melanoma Tumor Board™: Matching Treatment to Patient is a continuing medical education–certified activity in which Jeffrey S. Weber, MD, PhD; Omid Hamid, MD; Ragini Kudchadkar, MD; and Mario Sznol, MD; discuss the best strategies for integrating new melanoma therapies into practice.

This online activity concludes with a discussion of the next steps for patients with melanoma whose disease fails to respond to adjuvant therapy. The experts highlight ongoing melanoma clinical trials, new therapy targets, and novel combination therapy. Below are highlights of the topics covered during the activity.

  • Options for progression of BRAF-positive versus wild-type disease
  • Data from the phase III CheckMate 067 clinical trial of nivolumab and ipilimumab1
  • Clinical trials of new immune checkpoint therapy targets such as the combination of anti–PD-1 with anti–lymphocyte-activation gene 3 therapy2
  • Other novel treatment strategies such as oncolytic viruses as immunotherapies3

“[For disease that fails to respond to adjuvant therapy] you can offer anything from intratumoral agents in combination with anti–PD-1 or anti–CTLA-4. You can offer combinations that are based on anti–PD-1 with a whole variety of agents or combinations based on anti–CTLA-4, and that can be other agents that inhibit immune checkpoints, costimulatory agents, cytokines, [and] small molecules that alter, for example, monocyte macrophage function or T-cell function. There are so many options that one has out there.”

—Mario Sznol, MD

References

  1. Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Overall survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2017;377(14):1345-1356. doi: 10.1056/NEJMoa1709684.
  2. Ascierto PA, Melero I, Bhatia S, et al. Initial efficacy of anti-lymphocyte activation gene-3 (anti-LAG-3; BMS-986016) in combination with nivolumab (nivo) in pts with melanoma (MEL) previously treated with anti–PD-1/PD-L1 therapy. J Clin Oncol. 2017;35(suppl 15; abstr 9520). doi: 10.1200/JCO.2017.35.15_suppl.9520.
  3. Peters C, Grandi P, Nigim F. Updates on oncolytic virus immunotherapy for cancers. Mol Ther Oncolytics. 2019;12:259-262. doi: 10.1016/j.omto.2019.01.008.

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