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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.

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Acknowledgment of Commercial Support

This activity is supported by educational grants from Ferring Pharmaceuticals, Inc. and Merck & Co., Inc.

Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward

Release Date: July 31, 2019
Expiration Date: July 31, 2020
Media: Internet - based

Activity Overview

Now, even while clinicians are sorting through data from clinical studies of single-agent immunotherapy for advanced/metastatic urothelial cancer (UC), the field is poised to pivot again as a multitude of ongoing clinical studies are evaluating single-agent and combination immunotherapy (IO) strategies across all stages of bladder cancer. Additionally, novel agents are being studied to address the unmet needs of patients with UC that is refractory to immune checkpoint inhibitor therapy. Use of these agents across multiple lines of therapy for advanced UC and the potential expansion of their use to early-stage disease makes it imperative that urologists, as the primary care providers for patients with early-stage disease and the gatekeepers for referral to other specialists, understand both new data and best practices related to the use of IO, including proactively monitoring, mitigating, and managing immune-related adverse events. This interactive, online activity is based on a live symposium held adjunct to the 2019 annual urology meeting in Chicago. Through a series of brief video interviews, the multidisciplinary faculty—comprising renowned experts in urology, medical oncology, and IO—review practice-changing data and its impact on patient care, discuss “real-world” clinical cases, and share forward-looking perspectives on the bladder cancer treatment horizon.

Acknowledgement of Commercial Support

This activity is supported by educational grants from Ferring Pharmaceuticals, Inc. and 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 video files/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, 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/CE certificate upon completion of these steps.

Target Audience

This educational program is directed toward urologists, oncologists, and researchers involved in the treatment of patients with bladder cancers. Nurse practitioners, physician assistants, nurses, and other healthcare professionals interested in the treatment and management of patients with bladder cancers are also invited to participate.

Learning Objectives

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

  • Identify the rationale for using immunotherapy (IO)-based approaches to treat bladder cancer
  • Analyze key data from clinical trials of IO and other emerging agents for bladder cancer
  • Consider practice-changing evidence from clinical trials of IO, cytotoxic agents, and targeted therapies during multidisciplinary, team-based care planning for patients with bladder cancer
  • Outline immune-related adverse events and best practices for their mitigation and management

Faculty, Staff, and Planners’ Disclosures

Chair

Daniel P. Petrylak
Daniel P. Petrylak, MD
Professor of Medicine (Medical Oncology) and Urology
Director, Prostate and GU Medical Oncology
Director, Prostate Cancer Translational Research Group
Yale Cancer Center
New Haven, CT

Disclosures: Grant/Research Support: Ada Cap (Advanced Accelerator Applications), Astellas, AstraZeneca, Bayer, Bristol-Myers Squibb, Clovis, Eli Lilly, Endocyte, Genentech, Innocrin, MedImmune, Merck, Novartis, Pfizer, Progenics, Roche Laboratories, Sanofi Aventis, Seattle Genetics; Consultant: Ada Cap (Advanced Accelerator Applications), Amgen, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis, Eli Lilly, Exelixis, Incyte, Janssen, Pfizer, Pharmacyclics, Roche Laboratories, Seattle Genetics, Urogen; Shareholder: Bellicum, Tyme.

Faculty

Bernard H. Bochner
Bernard H. Bochner, MD
Attending Surgeon, Urology Service
Sir Murray Brennan Chair in Surgery
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Grant/Research Support: National Institutes of Health; Consultant: Genentech, Olympus.

Leonard G. Gomella
Leonard G. Gomella, MD, FACS
The Bernard W. Godwin Professor of Prostate Cancer
Chairman, Department of Urology
Senior Director for Clinical Affairs, Jefferson Kimmel Cancer Center
Clinical Director, Jefferson Kimmel Cancer Center Network
Thomas Jefferson University
Philadelphia, PA

Disclosures: Consultant: Astellas, Bayer, Merck, Strand; Other: NCI-NRG.

Maha Hussain
Maha Hussain, MD, FACP, FASCO
Genevieve Teuton Professor of Medicine
Division of Hematology/Oncology
Deputy Director
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine
Chicago, IL

Disclosures: Grant/Research Support: AstraZeneca, Pfizer, Bayer, Genentech; Consultant: Pfizer, AstraZeneca, Bayer; Other: Sanofi, Genzyme, Genentech.

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/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 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 any of the companies that provided commercial support for this program.

PER Pulse Recaps

1 of 3

Insights from Bernard H. Bochner, MD – PER Pulse™ Recap:
Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward

Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward is a series of short video interviews with faculty who address questions commonly faced by practicing urologists. The activity features discussions on:

  • Immunotherapy 101: A Primer for Urologists
  • Meeting Unmet Needs in Non–Muscle-Invasive Bladder Cancer
  • How Can We Optimize Outcomes in Muscle-Invasive Bladder Cancer?
  • Promising Novel Approaches: A Primer for Urologists

Throughout the activity, these experts answer questions about their decisions for case management and offer their perspectives and guidance on issues important to community-based healthcare providers.

This first of 3 PER Pulse™ Recaps summarizing the program focuses on Dr Bochner’s perspectives on meeting unmet needs in non–muscle-invasive bladder cancer (NMIBC). During this activity, Dr Bochner:

  • Discusses therapeutic options for a 72-year-old with NMIBC who did not respond to bacillus Calmette-Guérin (BCG) treatment, including cystectomy, clinical trials of immunotherapy (IO), and intravesical targeted therapies and chemotherapies
  • Reviews investigational IO strategies for NMIBC, including those aimed at addressing the ongoing BCG supply shortage and clinical trials of immunotherapy for BCG-refractory NMIBC
    • The phase II KEYNOTE-057 study of single-agent pembrolizumab for patients with BCG-unresponsive NMIBC demonstrated a 3-month complete response rate of 38.8%1
  • Offers practical guidance on use of immune checkpoint inhibitor therapy for early-stage bladder cancer, including:
    • Monitoring for progression and immune-related adverse events
    • Ensuring coordinated, multidisciplinary care

“Immunotherapy management for patients with NMIBC… now has become a team sport. [As urologists,] we have medical oncology colleagues that are very well versed in using many of these new IO agents. Working together as the experts in non–muscle-invasive disease, we can better serve our patients as we move beyond BCG in the future.”
— Bernard H. Bochner, MD

Reference

  1. Balar AV, Kulkarni GS, Uchio EM, et al. Keynote 057: phase II trial of pembrolizumab (pembro) for patients (pts) with high-risk (HR) nonmuscle invasive bladder cancer (NMIBC) unresponsive to bacillus Calmette-Guérin (BCG). J Clin Oncol. 2019;37(7 suppl; abstr 350). doi: 10.1200/JCO.2019.37.7.

2 of 3

Insights from Maha Hussain, MD – PER Pulse™ Recap:
Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward

Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward is a series of short video interviews with faculty who address questions commonly faced by practicing urologists. The activity features discussions on:

  • Immunotherapy 101: A Primer for Urologists
  • Meeting Unmet Needs in Non–Muscle-Invasive Bladder Cancer
  • How Can We Optimize Outcomes in Muscle-Invasive Bladder Cancer?
  • Promising Novel Approaches: A Primer for Urologists

Throughout the activity, these experts answer questions about their decisions for case management and offer their perspectives and guidance on issues important to community-based healthcare providers.

This second of 3 PER Pulse™ Recaps summarizing the program focuses on optimizing outcomes in muscle-invasive bladder cancer (MIBC). During this activity, Dr Hussain:

  • Discusses frontline therapeutic options for patients with metastatic MIBC, including cisplatin for eligible patients and immune checkpoint inhibition (ICPi; ie, atezolizumab or pembrolizumab) for cisplatin-ineligible patients with tumors expressing high levels of PD-L1, as well as practical issues related to pathology and testing to guide ICPi selection
  • How the introduction of ICPi in the neoadjuvant and adjuvant settings may impact urologists’ practice and their collaborative relationships with medical oncologists
  • Describes her experiences with immune-related adverse events (irAEs), offers guidance on irAE monitoring and management, and shares best practices regarding patient and caregiver communication and education about irAEs
  • Reviews important IO-based strategies for bladder cancer being evaluated in clinical trials, including intravesical therapies, systemic regimens for non-MIBC, and neoadjuvant and adjuvant (IO alone or IO–chemotherapy combinations) agents for MIBC that should be considered during treatment planning.

“The physicians who are using IO [for MIBC]—whether oncologists or urologists—need to be aware that IO is not without side effects….These side effects can occur as early as a few weeks into treatment and can linger beyond the stopping of the treatment. So it’s critical to be very well aware and informed of the potential side effects, to look for them, and apply periodic testing for side effects that might not be symptomatic.”
— Maha Hussain, MD


3 of 3

Insights from Daniel P. Petrylak, MD – PER Pulse™ Recap:
Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward

Community Practice Connections™: Bladder Cancer Working Group: Practical Application of Immunotherapeutic Strategies to Optimize Patient Outcomes, Next Steps to Move the Field Forward is a series of short video interviews with faculty who address questions commonly faced by practicing urologists. The activity features discussions on:

  • Immunotherapy 101: A Primer for Urologists
  • Meeting Unmet Needs in Non–Muscle-Invasive Bladder Cancer
  • How Can We Optimize Outcomes in Muscle-Invasive Bladder Cancer?
  • Promising Novel Approaches: A Primer for Urologists

Throughout the activity, these experts answer questions about their decisions for case management and offer their perspectives and guidance on issues important to community-based healthcare providers.

This third of 3 PER Pulse™ Recaps summarizing the program focuses on promising novel therapeutic approaches for advanced bladder cancer treatment about which urologists should be aware. During the interview, Dr Petrylak:

  • Discusses how FGFR-targeted agents will be integrated into the treatment landscape for bladder cancer
    • The approval of the FGFR inhibitor erdafitinib for patients with locally advanced or metastatic bladder cancer with an FGFR2 or FGFR3 alteration that has progressed during or following prior platinum-containing chemotherapy1
    • His opinion that this approval justifies early molecular testing
  • Shares his perspective on the increasing importance of a multidisciplinary approach taken by oncologists and urologists together when immunotherapy is used for patients with bladder cancer
  • Reviews results from studies of the antibody–drug conjugates enfortumab vedotin and sacituzumab govitecan for advanced bladder cancer in the post immune checkpoint inhibitor setting

“In their initial preliminary trials, [enfortumab vedotin and sacituzumab govitecan] have progression-free survivals that range between 5 and 7 months and overall survivals that are greater than 10 months. What’s interesting about these drugs is that they have responses across different subtypes of urothelial carcinoma, particularly those patients who are checkpoint-experienced, as well as those patients who have liver metastases.”
— Daniel P. Petrylak, MD

Reference

  1. FDA approves first targeted therapy for metastatic bladder cancer [news release]. Silver Spring, MD: FDA; April 12, 2019. fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm635906.htm. Accessed April 17, 2019.

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