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 Takeda Oncology.

Community Practice Connections™: Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients?

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

Activity Overview

In the management of non–small cell lung cancer (NSCLC), oncologists face a broad array of choices in the first-line setting of patients with advanced disease. With rapid growth in the field over the past 5 years, oncologists may face difficulties and gaps in evidence when determining the appropriate approach to patients with EGFR mutations and ALK rearrangements in the frontline and later-line settings. This comprehensive online program, featuring perspectives on key issues in management from David R. Gandara, MD; Roy S. Herbst, MD, PhD; Robert C. Doebele, MD, PhD; and Justin F. Gainor, MD, will enable rapid implementation of appropriate testing strategies for NSCLC, up-to-date approaches to sequencing therapies in patients with NSCLC, and the best evidence-based strategies for adverse event identification and management.

Benefits of Participating

  • Learn expert perspectives on the best strategies for sequencing therapies in NSCLC with specific mutational changes
  • Integrate the results of the latest clinical studies into your practice decisions
  • Recognize the role of liquid biopsy in screening patients for targetable mutations in lung cancer
  • Learn best practices for managing resistance to ALK and EGFR inhibitors over time
  • Hear the latest strategies for managing resistance to earlier-line treatments directly from the experts

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Takeda Oncology.

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 videos/content until you finish the presentation.
  • At the end of the activity, “Educational Content/Videos” 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 activity is directed toward medical oncologists who treat patients with lung cancer. Nurse practitioners, nurses, physician assistants, pharmacists, investigators, and other healthcare professionals interested in the treatment of lung cancer are also invited to participate.

Learning Objectives

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

  • Describe appropriate testing strategies that impact the development of optimal NSCLC treatment plans in the first line and beyond.
  • Describe newly approved and emerging targeted therapeutic strategies that can be administered in the clinical management of NSCLC with EGFR or ALK molecular aberrations.
  • Apply sequential targeted approaches to treat NSCLC with EGFR or ALK molecular aberrations.
  • Develop and implement strategies to monitor responses and mitigate treatment-related toxicities.

Faculty, Staff, and Planners’ Disclosures

Faculty

David R. Gandara
David R. Gandara, MD
Professor of Medicine Emeritus
Division of Hematology/Oncology
Director of Thoracic Oncology
Senior Advisor to the Director
University of California, Davis, Comprehensive Cancer Center
Sacramento, CA

Disclosures: Grant Research Support: Bristol-Myers Squibb, Roche-Genentech, Novartis, Merck; Consultant: AstraZeneca, Celgene, CellMax, Fujifilm, Roche-Genentech, Guardant Health, Inivata, IO Biotech, Lilly, Liquid Genomics, Merck, Samsung Bioepis, Pfizer.

Robert C. Doebele
Robert C. Doebele, MD, PhD
Director, Thoracic Oncology Research Initiative
Associate Professor of Medicine
University of Colorado Cancer Center
Aurora, CO

Disclosures: Consultant: AstraZeneca, Takeda, Genentech/Roche, Bayer, Rain Therapeutics; Shareholder: Rain Therapeutics; Other: Licensing of patents/biologic materials to Abbott Molecular, Rain Therapeutics, Black Diamond, Foundation Medicine, Genentech, PearlRiver.

Justin F. Gainor
Justin F. Gainor, MD
Director of Targeted Immunotherapy, Termeer Center for Targeted Therapies
Center for Thoracic Cancers, Massachusetts General Hospital
Assistant Professor of Medicine, Harvard Medical School
Boston, MA

Disclosures: Grant Research Support: Novartis, Genentech/Roche, Takeda; Consultant: Bristol-Myers Squibb, Takeda, Array, Oncorus, Blueprint, Loxo, Pfizer, Amgen, Agios, Regeneron, Jounce.

Roy S. Herbst
Roy S. Herbst, MD, PhD
Ensign Professor of Medicine (Medical Oncology)
Professor of Pharmacology
Chief of Medical Oncology
Associate Director for Translational Research
Yale Cancer Center, Smilow Cancer Hospital
New Haven, CT

Disclosures: Grant Research Support: AstraZeneca, Eli Lilly and Company, Merck and Company; Consultant: AbbVie Pharmaceuticals, ARMO BioSciences, AstraZeneca, Biodesix, Bristol-Myers Squibb, Eli Lilly and Company, EMD Serono, Genentech/Roche, Genmab, Heat Biologics, Halozyme, Loxo Oncology, Merck and Company, Nektar, NextCure, Novartis, Pfizer, Sanofi, Seattle Genetics, Shire PLC, Spectrum Pharmaceuticals, Symphogen, Tocagen, TESARO; Other: Scientific Advisory Board: Neon Therapeutics, Infinity Pharmaceuticals, NextCure; Board Member: Junshi Pharmaceuticals.

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 create a conflict of interest (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 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 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® or the companies that provided commercial support for this program.

PER Pulse Recaps

1 of 3

Insight from David R. Gandara, MD–PER Pulse™ Recap:
Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients?

Community Practice Connections™: Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients? is a continuing medical education–certified program. For this program, chair David R. Gandara, MD, was joined by Roy S. Herbst, MD, PhD; Robert C. Doebele, MD, PhD; and Justin F. Gainor, MD, to discuss the latest data in non–small cell lung cancer (NSCLC) with EGFR mutations and ALK rearrangements.

This first of 3 PER Pulse™ Recaps summarizing the online activity focuses on strategies for individualizing decision making regarding appropriate use of targeted and immunotherapeutic treatments across malignancies. Below are some highlights from the activity featuring Dr Gandara:

  • To optimally manage patients with NSCLC with EGFR and ALK mutations, it is important to identify the best strategies for detecting these mutations, clarifying the role of next-generation sequencing, understanding the role of tissue biopsy versus liquid biopsy, and determining the optimal sequencing of therapies to use in the first-line and second-line settings based on patterns of resistance.
  • Oncologists must be aware of ongoing and recently completed clinical trials to identify opportunities for patients to benefit from the latest combinations with ALK and EGFR inhibitors to overcome resistance and improve patient outcomes.1,2
  • First-line therapy in EGFR-mutated NSCLC may be selected based on the results of key clinical trials, such as the ARCHER150 trial with dacomitinib and the FLAURA trial with osimertinib.3-5
  • Understanding the design and key results of these trials informs sequencing of EGFR inhibitors in NSCLC. Taking into account the population of patients studied, the adverse event profile of treatments, and the relevant mutations at baseline is crucial in selecting the safest and most efficacious treatment for each patient.3-5

“It is becoming more and more the standard of care to do next-generation sequencing in lung cancer so that we can look for all the treatable abnormalities.”
—David R. Gandara, MD

References

  1. Aggarwal C, Thompson JC, Black TA, et al. Clinical implications of plasma-based genotyping with the delivery of personalized therapy in metastatic non-small cell lung. JAMA Oncol. 2019;5(2):173-180. doi: 10.1001/jamaoncol.2018.4305.
  2. Leighl NB, Page RD, Raymond VM, et al. Clinical utility of comprehensive cell-free DNA analysis to identify genomic biomarkers in patients with newly diagnosed metastatic non-small cell lung cancer. Clin Cancer Res. 2019;25(15):4691-4700. doi: 10.1158/1078-0432.CCR-19-0624.
  3. Wu YL, Lu S, Lu Y, et al. Results of PROFILE 1029, a phase III comparison of first-line crizotinib versus chemotherapy in East Asian patients with ALK-positive advanced non-small cell lung cancer. J Thorac Oncol. 2018;13(10):1539-1548. doi: 10.1016/j.jtho.2018.06.012.
  4. Soria JC, Tan DSW, Chiari R, et al. First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study [erratum in Lancet. 2017;389(10072):908]. Lancet. 2017;389(10072):917-929. doi: 10.1016/S0140-6736(17)30123-X.
  5. Mok TS, Cheng Y, Zhou X, et al. Improvement in overall survival in a randomized study that compared dacomitinib with gefitinib in patients with advanced non-small-cell lung cancer and EGFR-activating mutations. J Clin Oncol. 2018;36(22):2244-2250. doi: 10.1200/JCO.2018.78.7994.

2 of 3

Insight from Roy S. Herbst, MD, PhD–PER Pulse™ Recap:
Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients?

Community Practice Connections™: Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients? is a continuing medical education–certified program. For this program, Roy S. Herbst, MD, PhD, was joined by David R. Gandara, MD; Robert C. Doebele, MD, PhD; and Justin F. Gainor, MD, to discuss the latest data in non–small cell lung cancer (NSCLC) with EGFR mutations and ALK rearrangements.

This second of 3 PER Pulse™ Recaps summarizing the online activity focuses on strategies for individualizing decision making regarding appropriate use of targeted and immunotherapeutic treatments across malignancies. Below are some highlights from the activity featuring Dr Herbst:

  • In a study of 21,807 patients with treated, late-stage cancers across more than 50 cancer types, a next-generation sequencing assay was effective in identifying somatic alterations in 85% of all patients, 93% of patients with small cell lung cancer, and 87% of patients with NSCLC.1
  • In recent studies of patients with lung cancer, liquid biopsy has been shown to be highly reliable and effective in supplementing tissue-based biopsy for identification of targetable mutations.
  • In 229 patients with metastatic NSCLC, mutation detection rates increased from 20% to 36%, and in the NILE study, in 282 patients who underwent both tissue-based and plasma-based testing, use of circulating tumor DNA increased detection rates by 48%.2,3 As a result, use of the assays is sufficient for selection of treatment in cases when fine-needle aspiration does not yield sufficient tissue.
  • In a retrospective study of patients with NSCLC with EGFR T790M mutations detected by a plasma-based or tumor-based assay, overall response rates were similar in both groups of patients (62% [95% CI, 54%-70%] in patients with a T790M mutation detected by tumoral biopsy versus 63% [95% CI, 55%-70%] in patients with a T790M mutation detected by liquid biopsy).4

“And if you combine a liquid biopsy with a tissue biopsy, you could increase to 80% or 90% the chance that you will pick up a mutation in the patient.”
—Roy S. Herbst, MD, PhD

References

  1. Zill OA, Banks KC, Fairclough SR, et al. The landscape of actionable genomic alterations in cell-free circulating tumor DNA from 21,807 advanced cancer patients. Clin Cancer Res. 2018;24(15):3528-3538. doi: 10.1158/1078-0432.CCR-17-3837.
  2. Aggarwal C, Thompson JC, Black TA, et al. Clinical implications of plasma-based genotyping with the delivery of personalized therapy in metastatic non-small cell lung cancer. JAMA Oncol. 2019;5(2):173-180. doi: 10.1001/jamaoncol.2018.4305.
  3. Leighl NB, Page RD, Raymond VM, et al. Clinical utility of comprehensive cell-free DNA analysis to identify genomic biomarkers in patients with newly diagnosed metastatic non-small cell lung cancer. Clin Cancer Res. 2019; 25(15):4691-4700. doi: 10.1158/1078-0432.CCR-19-0624.
  4. Oxnard GR, Thress KS, Alden RS, et al. Association between plasma genotyping and outcomes of treatment with osimertinib (AZD9291) in advanced non-small-cell lung cancer. J Clin Oncol. 2016;34(28):3375-3382. doi: 10.1200/JCO.2016.66.7162.

3 of 3

Insight from Justin F. Gainor, MD–PER Pulse™ Recap:
Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients?

Community Practice Connections™: Oncogenic Tumor Board in Advanced NSCLC: How Do You Strategize Treatment Planning for EGFR-Mutated and ALK-Rearranged Patients? is a continuing medical education–certified program. For this program, Justin F. Gainor, MD, was joined by David R. Gandara, MD; Roy S. Herbst, MD, PhD; and Robert C. Doebele, MD, PhD, to discuss the latest data in non–small cell lung cancer (NSCLC) with EGFR mutations and ALK rearrangements.

This third of 3 PER Pulse™ Recaps summarizing the online activity focuses on strategies for individualizing decision making regarding appropriate use of targeted and immunotherapeutic treatments across malignancies. Below are some highlights from the activity featuring Dr Gainor:

  • Despite clear guidance from multiple societies and guidelines, rates of testing for ALK rearrangements and other mutations remain suboptimal in lung cancer.1-3
  • In a retrospective review of 814 patients with stage IIIB/IV NSCLC treated at community oncology practices from 2013 to 2015, only 59% received both EGFR and ALK testing.4
  • Testing for National Comprehensive Cancer Network–recommended targets of 7 oncogenes (ROS1, BRAF, RET, MET, HER2 in addition to EGFR and ALK) was performed in only 8% of patients.4
  • In the era of next-generation sequencing, testing for multiple mutations simultaneously (eg, PD-L1 and EGFR, ALK, ROS1, BRAF, MET, HER2, RET, and NTRK1) is cost-efficient and is associated with cost savings versus exclusionary, sequential testing and hotspot panels.5

“So far, I think what we’ve seen is that liquid biopsies can be quite useful as a complementary tool in helping identify…initial oncogenes driver events.”
—Justin F. Gainor, MD

References

  1. Novello S, Barlesi F, Califano R, et al; ESMO Guidelines Committee. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v1-v27. doi: 10.1093/annonc/mdw326.
  2. Melosky B, Blais N, Cheema P, et al. Standardizing biomarker testing for Canadian patients with advanced lung cancer. Curr Oncol. 2018;25(1):73-82. doi: 10.3747/co.25.3867.
  3. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142(3):321-346. doi: 10.5858/arpa.2017-0388-CP.
  4. Gutierrez ME, Choi K, Lanman RB, et al. Genomic profiling of advanced non-small cell lung cancer in community settings: gaps and opportunities. Clin Lung Cancer. 2017;18(6):651-659. doi: 10.1016/j.cllc.2017.04.004.
  5. Pennell NA, Mutebi A, Zhou Z-Y, et al. Economic impact of next-generation sequencing versus single-gene testing to detect genomic alterations in metastatic non–small-cell lung cancer using a decision analytic model [published online May 16, 2019]. JCO Precis Oncol. doi: 10.1200/PO.18.00356.

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