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.

Physicians’ Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669, for 1.5 Contact Hours.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Genomic Health Inc, Merck Sharp & Dohme Corp, and Novartis Pharmaceuticals Corporation.

Community Practice Connections™: 1st Annual Precision Medicine Symposium: An Illustrated Tumor Board


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

Activity Overview

This activity, featuring program chair Andre H. Goy, MD, MS; Corey J. Langer, MD; Andrew L. Pecora, MD, CPE; and Andrew Norden, MD, MPH, MBA, describes the state of the art in the treatment of lymphomas and of the cancer responsible for more annual deaths than any other—lung cancer. This program describes current practices in the classification of lymphomas and predictors of survival in lymphoma, as well as current treatment options. Emerging treatment options across lymphomas, including use of immunotherapy following transplant, are also discussed. In lung cancer, the integration of targeted therapy and checkpoint inhibitor therapy into treatment are reviewed, with a discussion of adverse event management strategies and perspectives on managing costs in the present era of ever-changing cancer care strategies.

Benefits of Participating

  • Learn best practices in management of lymphomas, including strategies for patient risk classification and management
  • Gain expert perspectives on emerging strategies for use of precision medicine in hematologic malignancies and solid tumors
  • Optimally sequence treatments in the management of EGFR-mutated and ALK-rearranged lung cancer based on expert interpretation of the latest clinical data
  • Recognize optimal strategies for use of immunotherapy in lung cancer
  • Formulate best practices for recognizing and managing adverse events associated with immunotherapy and targeted therapy

CME Activity Table of Contents

  • Module 1: Precision Medicine in Aggressive Lymphomas: A Model for Precision Medicine
  • Module 2: Therapeutic Landscape in NSCLC: Precision Medicine in 2019
  • Module 3: Checkpoint Inhibition as Consolidation Therapy After ASCT in Hematologic Malignancies
  • Module 4: The Need for Precise Data in the Era of Precision Medicine
  • Module 5: Conclusions

Acknowledgement of Commercial Support

This activity is supported by educational grants from Genomic Health Inc, Merck Sharp & Dohme Corp, and Novartis Pharmaceuticals Corporation.

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 audio files/content until you finish the presentation.
  • At the end of the activity, educational content/audio 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 activity is directed toward pathologists and oncologists, as well as nurses and fellows involved in the treatment and management of patients with cancers. Physician assistants, pharmacists, researchers, and other healthcare professionals may also participate.

Learning Objectives

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

  • Examine clinical studies in common malignancies and examine relevant biomarkers to select patients for therapy.
  • Utilize tumor pathology assessment reports to enable evidence-based treatment of malignancies.
  • Optimize diagnosis and management of malignancies through multidisciplinary cooperation.
  • Describe the current and evolving role of genomic assays in cancer management.
  • Identify potential applications of liquid biopsy in the assessment of commonly encountered malignancies.

Faculty, Staff, and Planners’ Disclosures

Faculty

Andre H. Goy
Andre H. Goy, MD, MS
Chairman and Director
Chief, Division of Lymphoma
John Theurer Cancer Center
Hackensack University Medical Center
Hackensack, NJ
Chief Science Officer and Director of Research and Innovation
Regional Cancer Care Associates
Hackensack, NJ
Professor and Chair, Department of Oncology
Seton Hall - Hackensack Meridian School of Medicine
Hackensack, NJ
Lydia Pfund Chair for Lymphoma
Professor of Medicine
Georgetown University School of Medicine
Washington, DC

Disclosures: Grant Research Support: JNJ; Celgene; Gilead/Kite clinical trial support through institution; Consultant: Celgene; Speakers’ Bureau: Takeda; JNJ/Pharmacyclics; Gilead/Kite; Shareholder: Cota Healthcare; Other: Member of Advisory Board: Cota; Celgene; Takeda; Pharmacyclics; J&J; Acerta; Gilead/Kite

Corey J. Langer
Corey J. Langer, MD
Director, Thoracic Oncology
Professor of Medicine
Hematology/Oncology Division
Hospital of the University of Pennsylvania
Abramson Comprehensive Cancer Center
Philadelphia, PA

Disclosures: Grant Research Support: Pfizer, Inc; Eli Lilly & Company; Genentech/Roche, Inc; OSI Pharmaceuticals, Inc; GlaxoSmithKline; Merck; Nektar; Advantagene; Inovio; Ariad (Takeda); Stemcentrx (AbbVie); Celgene; Incyte; Macrogenics; Consultant: Bristol-Myers Squibb Company; ImClone Systems Inc.; Eli Lilly & Company; Astra Zeneca Pharmaceuticals LP; Merck; Novartis Pharmaceuticals Corporation; Genentech, Inc; Bayer HealthCare Pharmaceuticals/Onyx Pharmaceuticals, Inc; Celgene Oncology; Abbott Laboratories; Biodesix; Clariant; CarisDx; ARIAD Pharmaceuticals, Inc; Boehringer Ingelheim Pharmaceuticals, Inc; Synta Pharmaceuticals Corporation; Clovis; Other: DSMC: Lilly; Amgen; Peregrine; Synta; SWOG; Incyte; VA; CME: PIK, NOCR, CCO, RTP.

Andrew Norden
Andrew Norden, MD, MPH, MBA
Chief Medical Officer
Cota, Inc
New York, NY

Disclosures: Shareholder: Cota Healthcare.

Andrew L. Pecora
Andrew L. Pecora, MD, CPE
President, Physician Enterprise
Chief Innovation Officer
Professor and Vice President of Cancer Services
John Theurer Cancer Center
Hackensack Meridian Health
Hackensack, NJ

Disclosures: Andrew Pecora has no relevant financial relationships with commercial interests 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/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
Insight from Andre H. Goy, MD – PER Pulse™ Recap:
1st Annual Precision Medicine Symposium: An Illustrated Tumor Board

Community Practice Connections™: 1st Annual Precision Medicine Symposium: An Illustrated Tumor Board is a continuing medical education (CME)-certified program. For this program, chair Andre H. Goy, MD, MS, was joined by Corey J. Langer, MD; Andrew L. Pecora, MD, CPE; and Andrew Norden, MD, MPH, MBA, to discuss the latest data in precision medicine across solid and liquid tumors.

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

  • Lymphoma is the most common blood cancer, with the American Cancer Society projecting 2019 totals of 82,310 new diagnoses and 20,970 deaths resulting from lymphomas. Patients are diagnosed with the most common subtype, diffuse large B-cell lymphoma (DLBCL), at a median age of 66 years, with the incidence increasing with advancing age.1,2 With present therapy, more than half of cases are curable. However, untreated, survival is measured in weeks to months.3
  • B-cell lymphomas are highly heterogenous, with more than 50 entities within the mature B-cell neoplasms, 18 of which are subtypes of DLBCL. This classification is based on morphological and biological alterations in not only genetic characteristics, but also epigenetic and protein-level differences. These distinct molecular subtypes correspond with distinct biological pathways of the genesis of lymphoma.4,5
  • Outcomes are poor for the 20% to 30% of patients who experience early relapse on therapy and the 10% to 15% of patients who experience primary failure on therapy. Approximately 80% of failures occur within the first 18 months after treatment. Conversely, in patients who achieve 24 months of event-free survival, fewer than 7% of patients experience relapse.6,7
  • The SCHOLAR-1 retrospective study showed a median survival of 7.1 months in primary refractory patients, a 6.1-month median overall survival (OS) in patients refractory to second-line or later-line therapy, and a mere 6.2-month median OS in patients who experience relapse within a year of autologous stem cell transplant (SCT). In the same study, only 26% of patients experiencing relapse had any response to chemotherapeutic treatment, and the rate of complete response was a paltry 7%. A major unmet need exists in patients with DLBCL who are refractory to chemotherapy.8

References

  1. Cancer facts & figures 2019. American Cancer Society website. cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html. Accessed June 10, 2019.
  2. Armitage JO, Carde P, Wolf M. Non-Hodgkin’s lymphoma: treatment of large cell lymphomas. Rev Invest Clin. 1994;Suppl:83-88.
  3. Teras LR, DeSantis CE, Cerhan JR, et al. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA Cancer J Clin. 2016;66(6):443-459. doi: 10.3322/caac.21357.
  4. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-2390. doi: 10.1182/blood-2016-01-643569.
  5. Chapuy B, Stewart C, Dunford AJ, et al. Molecular subtypes of diffuse large B cell lymphoma are associated with distinct pathogenic mechanisms and outcomes [published corrections appear in Nat Med. 2018;24(8):1290-1291, 1292]. Nat Med. 2018;24(5):679-690. doi: 10.1038/s41591-018-0016-8.
  6. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B-cell lymphoma. N Engl J Med. 2002;346(4):235-242. doi: 10.1056/NEJMoa011795.
  7. Maurer MJ, Ghesquières H, Jais JP, et al. Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol. 2014;32(10):1066-1073. doi: 10.1200/JCO.2013.51.5866.
  8. Crump M, Neelapu SS, Farooq U, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017;130(16):1800-1808. doi: 10.1182/blood-2017-03-769620.

2 of 3
Insight from Corey J. Langer, MD – PER Pulse™ Recap:
1st Annual Precision Medicine Symposium: An Illustrated Tumor Board

Community Practice Connections™: 1st Annual Precision Medicine Symposium: An Illustrated Tumor Board is a continuing medical education (CME)-certified program. For this program, Corey J. Langer, MD, was joined by Andre H. Goy, MD, MS; Andrew L. Pecora, MD, CPE; and Andrew Norden, MD, MPH, MBA, to discuss the latest data in precision medicine across solid and liquid tumors.

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

  • Many developments in the treatment of non–small cell lung cancer (NSCLC) with checkpoint inhibitors and targeted therapies have emerged over the past 5 years.1
  • Targeted therapies are the treatment of choice in patients with NSCLC and targetable mutations, such as EGFR and ALK mutations. Moreover, of these agents, use of third-generation EGFR and ALK inhibitors is preferred in first-line treatment of patients with NSCLC and targetable mutations, due to the superior efficacy of these agents and the lower rate of patient progression to development of brain metastases.1
  • Publication of the FLAURA trial marked a major landscape-altering moment in NSCLC. In this study, frontline osimertinib versus comparator therapy of either erlotinib or gefitinib in 556 patients with activating EGFR mutations significantly improved progression-free survival (PFS; 18.9 vs 10.2 months; HR, 0.46; P <.0001) and showed a nonsignificant trend toward improved OS (HR, 0.63; P = .0068 [threshold of P = .0015 for significance]). In FLAURA, benefits in patients with and without central nervous system (CNS) metastases at study entry have been identified. Importantly, however, CNS progression events occurred in 6% of patients receiving osimertinib versus 15% of patients receiving standard-of-care treatment.2
  • Although first-line therapy with erlotinib, afatinib, or gefitinib results in a median PFS of approximately 11 months, 35% of patients do not survive to receive second-line treatment. Using osimertinib in the surviving group of patients would result in a median PFS of 9 months. This compares unfavorably with the median PFS of 19 months with osimertinib as first-line therapy. As a result, osimertinib is a standard-of-care first-line treatment of NSCLC.1,2
  • Attempts to improve on the PFS rates with first-generation agents include addition of chemotherapy to gefitinib in a Japanese trial presented at the 2018 American Society of Clinical Oncology Annual Meeting. Results showed a significant benefit in terms of both PFS (20.9 vs 11.2 months; HR, 0.494; P <.001) and OS (52.2 vs 38.8 months; HR, 0.695; P = .013).3

References

  1. NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer, version 5.2019. National Comprehensive Cancer Network website. nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published June 7, 2019. Accessed June 18, 2019.
  2. 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.
  3. Nakamura A, Inoue A, Morita S, et al. Phase III study comparing gefitinib monotherapy (G) to combination therapy with gefitinib, carboplatin, and pemetrexed (GCP) for untreated patients (pts) with advanced non-small cell lung cancer (NSCLC) with EGFR mutations (NEJ009). J Clin Oncol. 2018;36(15 suppl):9005. doi: 10.1200/JCO.2018.36.15_suppl.9005.

3 of 3
Insight from Andrew L. Pecora, MD, CPE – PER Pulse™ Recap:
1st Annual Precision Medicine Symposium: An Illustrated Tumor Board

Community Practice Connections™: 1st Annual Precision Medicine Symposium: An Illustrated Tumor Board is a continuing medical education (CME)-certified program. For this program, Andrew L. Pecora, MD, CPE, was joined by Andre H. Goy, MD, MS; Corey J. Langer, MD; and Andrew Norden, MD, MPH, MBA, to discuss the latest data in precision medicine across solid and liquid tumors.

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

  • Although allogeneic SCT is the best hope for cure in patients with hematologic malignancies, this strategy is associated with a significant risk of morbidity and mortality that has changed little over time.
  • Following autologous SCT, the immune system dramatically upregulates T regulatory cells, suppresses T effector cells, and upregulates natural killer cells. As cancer cells die and release neoantigens and antigens, checkpoint inhibitors may help enhance these effects to help kill cancer cells.1-3
  • In a phase Ib clinical trial, patients received ipilimumab and nivolumab after consolidation for autologous SCT in patients with a variety of hematologic malignancies, including primary refractory or relapsed/refractory peripheral T-cell lymphoma, DLBCL, and multiple myeloma. In patients receiving combination consolidation checkpoint inhibitor therapy, the complete response rate was 57% in primary refractory DLBCL, 14% in autologous SCT–naïve patients with high-risk multiple myeloma, and 40% in post autologous SCT [relapsed multiple myeloma. Importantly, complete response rates with these agents increased steadily, increasing to 83%, 71%, and 100% in these respective populations.4
  • Despite the potential for adverse events, the high rates of complete response observed with combination checkpoint inhibition consolidation in patients receiving autologous SCT are impressive. Enrolling patients in a phase II trial of checkpoint inhibition in DLBCL will provide more definitive answers about this promising strategy.

References

  1. Joyce JA, Pollard JW. Microenvironmental regulation of metastasis. Nat Rev Cancer. 2009;9(4):239-252. doi: 10.1038/nrc2618.
  2. Noy R, Pollard JW. Tumor-associated macrophages: from mechanisms to therapy [published correction appears in Immunity. 2014;41(5):866]. Immunity. 2014;41(1):49-61. doi: 10.1016/j.immuni.2014.06.010.
  3. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12(4):252-264. doi: 10.1038/nrc3239.
  4. Skarbnik AP, Donato ML, Korngold R, et al. Safety and efficacy data for combined checkpoint inhibition with ipilimumab (Ipi) and nivolumab (Nivo) as consolidation following autologous stem cell transplantation (ASCT) for high-risk hematological malignancies — CPIT-001 trial. Blood. 2018;132:256. http://www.bloodjournal.org/content/132/Suppl_1/256.

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