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 AstraZeneca.

Community Practice Connections™: Optimizing Pathologic Assessment in Lung Cancer: A Focus on Patients With EGFR Mutations

Release Date: November 6, 2019
Expiration Date: November 6, 2020
Media: Internet - based

Activity Overview

This activity features the Community Practice Connections™ platform, consisting of video clips featuring interviews with pathologists and oncologists who specialize in the diagnosis and treatment of patients with lung cancer, with a focus on lung disease expressing EGFR mutations. This online educational activity addresses topics such as current and best practices for pathologic assessment, identification of important mutations that help to direct management decisions, epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) therapies available for various clinical scenarios, and other pertinent considerations in lung cancer.

Benefits of Participating

  • Listen as experts discuss various clinical scenarios
  • Refresh your knowledge regarding mechanisms underlying disease progression and resistance to therapy
  • Learn something new about lung carcinoma and improve your clinical practice
  • Be reminded of the importance of a multidisciplinary approach to care

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

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 program is directed toward the American Society for Clinical Pathology audience and pathologists. Other healthcare professionals involved in the diagnosis and treatment of cancer are invited to participate.

Learning Objectives

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

  • Evaluate the utility of liquid biopsy and tumor biopsy as a pathologic approach to inform the choice of initial and later-line therapies for advanced EGFR mutation–positive non–small cell lung cancer (NSCLC)
  • Assess clinical data in the management of advanced NSCLC among patients with EGFR mutations
  • Relate appropriate management strategies for acquired resistance and communicate pathologic diagnostic information to the care team to optimize patient care
  • Define appropriate strategies for the management of patients with advanced NSCLC and EGFR mutations in the setting of brain metastases and to proactively plan to care for treatment-related adverse events

Faculty, Staff, and Planners’ Disclosures

Faculty

Lynette M. Sholl
Lynette M. Sholl, MD
Associate Professor, Pathology
Harvard Medical School
Associate Pathologist
Brigham and Women’s Hospital
Boston, MA

Disclosures: Grant Research Support: Roche/Genentech; Consultant: Loxo Oncology; Other: Honorarium: AstraZeneca.

Jonathan W. Goldman
Jonathan W. Goldman, MD
Associate Professor, University of California, Los Angeles (UCLA), Hematology & Oncology
Associate Director of Drug Development
Director of Clinical Trials in Thoracic Oncology
UCLA Health
Santa Monica, CA

Disclosures: Grant Research Support: AstraZeneca, Bristol-Myers Squibb, Genentech, MedImmune, Merck, Spectrum; Consultant: AstraZeneca, Genentech; Speakers Bureau: Merck.

Balazs Halmos
Balazs Halmos, MD, MS
Professor of Clinical Medicine
Director, Thoracic/Head and Neck Oncology
Director, Clinical Cancer Genomics
Albert Einstein College of Medicine/Montefiore Medical Center
Bronx, NY

Disclosures: Grant Research Support: AbbVie, AstraZeneca, Boehringer, Bristol-Myers Squibb, Guardant Health, GlaxoSmithKline, Merck, Mirati, Novartis, Pfizer; Consultant: AstraZeneca, Boehringer, Bristol-Myers Squibb, GH360, Merck, Novartis, Pfizer.

Ignacio I. Wistuba
Ignacio I. Wistuba, MD
Professor and Chair, Department of Translational Molecular Pathology
Anderson Clinical Faculty Chair for Cancer Treatment and Research
The University of Texas MD Anderson Cancer Center
Houston, TX

Disclosures: Grant Research Support: 4D, Adaptive, Adaptimmune, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, DEPArray, EMD Serono, Genentech, HTG Molecular, Johnson & Johnson, Karus, MedImmune, Merck, Novartis, Pfizer, Takeda; Consultant: AstraZeneca, Asuragen, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, HTG Molecular, KSD Technologies, Merck, Pfizer, Roche; Speakers Bureau: Guardant Health, Merck Sharp & Dohme Corp, Pfizer, Roche.

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, PER® makes it a policy to ensure fair balance, independence, objectivity, and scientific rigor in all 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 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 CME purposes only and is not meant to substitute for the independent clinical judgment of a physician 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® or the company that provided commercial support.

PER Pulse™ Recaps

1 of 3

Community Practice Connections™: Optimizing Pathological Assessment in Lung Cancer: A Focus on Patients With EGFR Mutations is a continuing medical education–certified activity in which Lynette M. Sholl, MD, discusses pathologic assessment and treatment options when caring for patients with EGFR-mutant non–small cell lung cancer (NSCLC).

This online activity begins with an overview of the pathological assessment of lung carcinoma. Below are highlights of the topics covered during the activity.

  • Advancements in the diagnosis of lung cancer1
  • Overview of mutations and co-mutations that have thus far been identified
  • Summary of the 2018 guideline recommendations for molecular testing2
  • Benefits and challenges of reflex testing3

“It is really essential today to make a clear distinction between adenocarcinoma and squamous cell carcinoma, in particular, because we recognize a very striking enrichment in terms of oncogenic driver alterations that are particularly targetable in adenocarcinoma. That same pattern of alterations is typically not seen in squamous carcinoma.”

—Lynette M. Sholl, MD

References

  1. Travis WD, Brambilla E, Nicholson AG, et al; WHO Panel. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10(9):1243-1260. doi: 10.1097/JTO.0000000000000630.
  2. 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. J Thorac Oncol. 2018;13(3):323-358. doi: 10.1016/j.jtho.2017.12.001.
  3. Lim C, Tsao MS, Le LW, et al. Biomarker testing and time to treatment decision in patients with advanced nonsmall-cell lung cancer. Ann Oncol. 2015;26(7):1415-1421. doi: 10.1093/annonc/mdv208.

2 of 3

Community Practice Connections™: Optimizing Pathological Assessment in Lung Cancer: A Focus on Patients With EGFR Mutations is a continuing medical education–certified activity in which Balazs Halmos, MD, MS, talks about managing acquired resistance and progressive EGFR mutation–positive non–small cell lung cancer (NSCLC).

This online activity features dialogues regarding tyrosine kinase inhibitor (TKI) therapy, small cell lung cancer (SCLC) transformation, and oligoprogressive NSCLC. Below are highlights of the topics covered during the activity.

  • Clinical data supporting first-line, third-generation TKI therapy for EGFR T790M mutation–positive NSCLC1-10
  • Features indicative of SCLC transformation from adenocarcinoma
  • Clinical trials aimed at preventing SCLC transformation
  • Individualized treatment options for oligoprogressive disease

“The phase III FLAURA study was a pivotal, positive, and practice-changing study. [Results of] this critical study showed that osimertinib yields a very impressive improvement in progression-free survival, on average of about 19 months, which is very, very impressive.”

—Balazs Halmos, MD, MS

References

  1. Oxnard GR, Arcila ME, Sima CS, et al. Acquired resistance to EGFR tyrosine kinase inhibitors in EGFR-mutant lung cancer: distinct natural history of patients with tumors harboring the T790M mutation. Clin Cancer Res. 2011;17(6):1616-1622. doi: 10.1158/1078-0432.CCR-10-2692.
  2. Yu HA, Arcila ME, Rekhtman N, et al. Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers. Clin Cancer Res. 2013;19(8):2240-2247. doi: 10.1158/1078-0432.CCR-12-2246.
  3. Hanna N, Johnson D, Temin S, et al. Systemic therapy for stage IV non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(30):3484-3515. doi: 10.1200/JCO.2017.74.6065.
  4. Novello S, Barlesi F, Califano R, et al. 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.
  5. Cross DA, Ashton SE, Ghiroghiu S, et al. AZD9291, an irreversible EGFR TKI, overcomes T790M-mediated resistance to EGFR inhibitors in lung cancer. Cancer Discov. 2014;4(9):1046-1061. doi: 10.1158/2159-8290.CD-14-0337.
  6. Mok T, Ahn M-J, Han J-Y, et al. CNS response to osimertinib in patients (pts) with T790M-positive advanced NSCLC: data from a randomized phase III trial (AURA3). J Clin Oncol. 2017;35(suppl 15):9005. doi: 10.1200/JCO.2017.35.15_suppl.9005.
  7. Mok TS, Wu Y-L, Ahn M-J, et al; AURA3 Investigators. Osimertinib or platinum-pemetrexed in EGFR T790M-positive lung cancer. N Engl J Med. 2017;376(7):629-640. doi: 10.1056/NEJMoa1612674.
  8. Goss G, Tsai CM, Shepherd FA, et al. Osimertinib for pretreated EGFR Thr790Met-positive advanced non-small-cell lung cancer (AURA2): a multicenter, open-label, single-arm, phase 2 study. Lancet Oncol. 2016;17(12):1643-1652. doi: 10.1016/S1470-2045(16)30508-3.
  9. Ballard P, Yates JW, Yang Z, et al. Preclinical comparison of osimertinib with other EGFR-TKIs in EGFR-mutant NSCLC brain metastases models, and early evidence of clinical brain metastases activity. Clin Cancer Res. 2016;22(20):5130-5140. doi: 10.1158/1078-0432.CCR-16-0399.
  10. Soria J-C, Yuichiro O, Vansteenkiste J, et al; FLAURA Investigators. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med. 2018;378(2):113-125. doi: 10.1056/NEJMoa1713137.

3 of 3

Community Practice Connections™: Optimizing Pathological Assessment in Lung Cancer: A Focus on Patients With EGFR Mutations is a continuing medical education–certified activity in which Balazs Halmos, MD, MS, talks about managing acquired resistance and progressive EGFR mutation–positive non–small cell lung cancer (NSCLC).

This online activity concludes with a discussion of how to treat patients with NSCLC and brain metastases. Local and systemic options, including currently approved and new targeted therapies, are discussed. Below are highlights of the topics covered during the activity.

  • Multidisciplinary options for treating brain metastases1,2
  • Clinical data supporting approval of ALK inhibitors3
  • Clinical trials of osimertinib for this indication4,5
  • MET and RET as novel targets6-8

“The second-most-common targetable mutation in NSCLC is ALK translocation. The previous drug, crizotinib, was a good drug in many ways, but one of its main failings was not very good CNS [central nervous system] penetration…and that’s where the newer [ALK] drugs have really stood out in particular. Alectinib and brigatinib have first-line studies comparing [them with] crizotinib where the newer drugs show significant benefit in really all parameters—systemic control and also CNS control.”

—Jonathan W. Goldman, MD

References

  1. Novello S, Barlesi F, Califano R, et al. 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. Soffietti R, Abacioglu U, Baumert B, et al. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro Oncol. 2017;19(2):162-174. doi: 10.1093/neuonc/now241.
  3. Ballard P, Yates JW, Yang Z, et al. Preclinical comparison of osimertinib with other EGFR-TKIs in EGFR-mutant NSCLC brain metastases models, and early evidence of clinical brain metastases activity. Clin Cancer Res. 2016;22(20):5130-5140. doi: 10.1158/1078-0432.CCR-16-0399.
  4. Soria JC, Ohe Y, Vansteenkiste J, et al; FLAURA Investigators. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med. 2018;378(2):113-125. doi: 10.1056/NEJMoa1713137.
  5. Oral Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors, AZD3759 or AZD9291, in Patients Who Have Advanced Non-Small Cell Lung Cancer (BLOOM). clinicaltrials.gov/ct2/show/NCT02228369. Updated August 29, 2019. Accessed October 29, 2019.
  6. Wolf J, Setons T, Han J-Y, et al. Capmatinib (INC280) in METex14-mutated advanced non-small cell lung cancer (NSCLC): efficacy data from the phase II GEOMETRY mono-1 study. J Clin Oncol. 2019;37 (suppl 15; abstr 9004). doi: 10.1200/JCO.2019.37.15_suppl.9004.
  7. Pain PK, Veillon R, Cortot AB, et al. Phase II study of tepotinib in NSCLC patients with METex14 mutations. J Clin Oncol. 2019;37 (suppl 15; abstr 9005). doi: 10.1200/JCO.2019.37.15_suppl.9005.
  8. Oxnard GR, Subbiah V, Park K, et al. Clinical activity of LOXO-292, a highly selective RET inhibitor, in patients with RET fusion+ non-small cell lung cancer: an update from ASCO 2018. Presented at: International Association for the Study of Lung Cancer 19th World Conference on Lung Cancer; September 23-26, 2018; Toronto, Canada.

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