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 1.0 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 Pfizer, Inc.

Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting

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

Activity Overview

Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting consists of a series of interactive clinical vignettes, short video interviews with leading experts in renal cell carcinoma (RCC), and short summaries of clinical data related to these issues. The video interviews address decision points in the clinical vignettes, as well as questions commonly faced in the community oncology practice setting.

Benefits of Participating

Participating in this online program will provide you with:

  • Perspectives on early-stage renal cell carcinoma (RCC) management from specialists in urology and medical oncology
  • Best practices for risk assessment and patient selection for adjuvant RCC therapy
  • An understanding of how to integrate data from trials of adjuvant systemic therapy for RCC into overall multidisciplinary care planning
  • An understanding of how to balance the potential benefits and risks of each management option in the post-nephrectomy setting

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Pfizer, 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 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 urologists, medical oncologists, surgical oncologists, and radiation oncologists interested in the treatment of renal cell carcinoma. Nurse practitioners, physician assistants, nurses, and other healthcare professionals involved in the treatment and management of patients with renal cell carcinoma will be invited to participate.

Learning Objectives

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

  • Substantiate treatment decisions across multidisciplinary teams for patients with early-stage renal cell carcinoma (RCC) based on the most pertinent clinical trial evidence for targeted therapy.
  • Integrate knowledge of patient selection for adjuvant therapy in the context of mechanisms of action, kinetics of response, best practices in monitoring, and key information that informs adjuvant treatment in the care of patients with RCC.
  • Manage treatment-related toxicities as a component of therapeutic decision making in adjuvant treatment settings for patients with RCC.
  • Evaluate recent clinical trial data, key ongoing trials, and how emerging adjuvant strategies may further impact the RCC treatment landscape.

Faculty, Staff, and Planners’ Disclosures

Faculty

Robert A. Figlin
Robert A. Figlin, MD, FACP
Steven Spielberg Family Chair in Hematology Oncology
Professor of Medicine and Biomedical Sciences
Director, Division of Hematology Oncology
Deputy Director, Integrated Oncology Service Line
Deputy Director, Samuel Oschin Comprehensive Cancer Institute
Cedars-Sinai Medical Center
Los Angeles, CA

Disclosures: Robert Figlin has no relevant financial relationships with commercial interest to disclose.

Daniel J. George
Daniel J. George, MD
Professor of Medicine and Surgery
Co-Director of the DCI Prostate and Urologic Cancer Center
Director of GU Oncology
Duke University School of Medicine
Durham, NC

Disclosures: Grant Research Support: Acerta, Astellas, Bayer, Bristol-Myers Squibb, Calithera, Dendreon, Exelixis, Janssen, Novartis, Pfizer, Sanofi; Consultant: Astellas, Bayer, Bristol-Myers Squibb, Exelixis, Flatiron, Janssen, Leidos Biomedical, Merck, Myovant Sciences, Pfizer, Sanofi; Speakers Bureau: Bayer, Exelixis, Sanofi.

Bradley C. Leibovich
Bradley C. Leibovich, MD
Chair, Department of Urology
David C. Utz, M.D. Professor of Urology
Mayo Clinic
Rochester, MN

Disclosures: Bradley Leibovich has no relevant financial relationship with commercial Interest to disclose.

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 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 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 Robert A. Figlin, MD, FACP; Daniel J. George, MD, and Bradley C. Leibovich, MD – PER Pulse™ Recap:
Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting

Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting is a series of short video interviews with faculty who address questions commonly faced by practicing oncologists. The activity features these discussions:

  • Multidisciplinary Care for Patients With Early-Stage RCC: A Urologist’s Perspective
  • Systemic Adjuvant Therapy for Early-Stage RCC at High Risk of Recurrence
  • Addressing Key Questions in the Field Related to the Adjuvant Management of RCC

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

This first of 3 PER Pulse™ Recaps summarizing the program focuses on the multidisciplinary care for patients with early-stage renal cell carcinoma (RCC). During this activity, Drs. George and Leibovich:

  • Discuss their approach for a 58-year-old with locally advanced clear-cell RCC who undergoes radical nephrectomy and is at high risk of disease recurrence, including risk-based treatment planning that considers standards of care and available clinical trials
  • Review how they engage a multidisciplinary team throughout evaluation, treatment planning, and management of early-stage RCC to optimize patient outcomes
  • Describe available risk stratification algorithms to guide clinical decision making in the adjuvant setting and emerging approaches that may improve patient selection
    • Dr. Leibovich explains that it is important to select a risk-profiling tool that has been validated to predict an outcome of interest in a relevant population

“Improvements in risk scoring for patients need to move from the systems that work well for a patient population and can be fairly accurate for a large population of patients to risk-profile systems that are based on individual parameters for that patient, and not only tumor-specific factors, such as genomics of the tumor, but patient-specific factors...”
— Bradley C. Leibovich, MD


2 of 3

Insights from Robert A. Figlin, MD, FACP; Daniel J. George, MD; and Bradley C. Leibovich, MD – PER Pulse™ Recap:
Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting

Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting is a series of short video interviews with faculty who address questions commonly faced by practicing oncologists. The activity features these discussions:

  • Multidisciplinary Care for Patients With Early-Stage RCC: A Urologist’s Perspective
  • Systemic Adjuvant Therapy for Early-Stage RCC at High Risk of Recurrence
  • Addressing Key Questions in the Field Related to the Adjuvant Management of RCC

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 health care providers.

This second of 3 PER Pulse™ Recaps summarizing the program focuses on a critical assessment of data from clinical trials of systemic adjuvant treatment for high-risk, early-stage renal cell carcinoma (RCC). During this activity, Dr. George:

  • Reviews the positive data from the S-TRAC trial1,2 of adjuvant sunitinib versus placebo among patients with RCC and high risk of recurrence (ROR) post nephrectomy (24% reduction and 5-year absolute 8% reduction in ROR among patients receiving sunitinib)
  • Discusses the important differences in adjuvant trials of tyrosine kinase inhibitors for RCC—S-TRAC, ATLAS, ASSURE, and PROTECT—that may have affected their outcomes, including eligibility criteria (eg, disease risk groups and histology), starting dose, and allowed dose reductions/interruptions
  • Shares his thoughts on the rationale for ongoing investigations of neoadjuvant and adjuvant strategies for nonmetastatic RCC, including adjuvant combination therapy with PD-1/PD-L1 plus CTLA-4 versus PD-1/PD-L1 alone and neoadjuvant plus adjuvant PD-1 therapy

“It’s an exciting time in renal cell carcinoma in the last few years. We’ve seen the clinical benefits associated with PD-1/PD-L1 inhibition in this setting, as well as the combinations of PD-1 and CTLA-4 inhibition in the metastatic setting…The question now is, can they translate into the adjuvant setting?”
— Daniel J. George, MD

References

  1. Ravaud A, Motzer RJ, Pandha HS, et al; S-TRAC Investigators. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. N Engl J Med. 2016;375(23):2246-2254. doi: 10.1056/NEJMoa1611406.
  2. Motzer RJ, Ravaud A, Patard JJ, et al. Adjuvant sunitinib for high-risk renal cell carcinoma after nephrectomy: subgroup analyses and updated overall survival results. Eur Urol. 2018;73(1):62-68. doi: 10.1016/j.eururo.2017.09.008.

3 of 3

Insights from Robert A. Figlin, MD, FACP; Daniel J. George, MD; and Bradley C. Leibovich, MD – PER Pulse™ Recap:
Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting

Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting is a series of short video interviews with faculty who address questions commonly faced by practicing oncologists. The activity features these discussions:

  • Multidisciplinary Care for Patients With Early-Stage RCC: A Urologist’s Perspective
  • Systemic Adjuvant Therapy for Early-Stage RCC at High Risk of Recurrence
  • Addressing Key Questions in the Field Related to the Adjuvant Management of RCC

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 health care providers.

This third of 3 PER Pulse™ Recaps summarizing the program focuses on practical issues related to the adjuvant management of renal cell carcinoma (RCC). During the interview, the faculty:

  • Discuss their overall approaches to adjuvant therapy for patients with early-stage, high-risk RCC based on available data, including:
    • A balanced discussion about all treatment options, including clinical trials
    • Ensuring patients clearly understand their individual risk stratification
  • Share their perspectives on the shift in perception of adjuvant therapy for RCC among medical oncologists, urologists, and patients, as well as areas for improvement in communication and coordination of care across a patient’s health care team:
    • Dr. Leibovich explains that he now considers it mandatory to discuss with patients management options in the adjuvant setting (eg, observation, approved systemic therapy, available clinical trials)
    • Dr. George describes that his experience and patient surveys suggest that patients accept adjuvant systemic therapy as a treatment option; he encourages the urology field to embrace the possibility of improving the outcomes of patients with RCC at high risk of recurrence after nephrectomy
  • Review the evolving adjuvant treatment landscape for RCC, including ongoing trials of immunotherapeutic agents alone and combined with targeted therapy and how oncologists and urologists can incorporate this into their treatment decision making with patients

“[Ensuring clinical trial] participation and active accrual and understanding that the adjuvant therapy of [patients with] kidney cancer is an unmet medical need remain paramount.”
— Robert A. Figlin, MD, FACP


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