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 live activity 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 an educational grant from AstraZeneca.
Medical Crossfire®: How to Use Liquid Biopsies Throughout the Lung Cancer Treatment Continuum Online
Release Date: January 31, 2018
Expiration Date: January 31, 2019
Media: Internet - based
Online Activity - Medical Crossfire®: How to Use Liquid Biopsies Throughout the Lung Cancer Treatment Continuum will update oncology healthcare professionals involved in the treatment of patients with lung cancer by providing expert guidance, interpretation, and opinions on the importance and impact of liquid biopsy testing through multiple lines of therapy. This activity features 4 modules, which will present multiple expert points-of-view on this rapidly evolving area of molecular testing. In Module 1, the role of tumor genotyping in treatment decision making will be discussed, as well as the strengths and weaknesses of conventional tissue-based testing. Module 2 will outline the scientific basis for liquid-based molecular testing, including current data on the levels of concordance between liquid- and tissue-based genotyping. Module 3 will incorporate case-based discussion on the real-world application of liquid biopsies, including issues regarding turnaround time, sensitivity, and specificity. Finally, Module 4 will address outstanding questions and potential future applications of liquid-based biopsies.
Acknowledgement of Commercial Support
This activity is supported by an educational grant from AstraZeneca.
CME/CE Table of Contents
- Segment 1. The Current Treatment Landscape in NSCLC: Tailoring Therapy to the Tumor
- Segment 2. Liquid Biopsy: Scientific Basis and Approaches
- Segment 3. Liquid Biopsy Today: How Do We Really Use It?
- Segment 4. Outstanding Questions in the Clinical Use of Liquid Biopsy and Closing Remarks
Requirements for Successful Completion
This educational activity is intended for medical oncologists, pathologists, and fellows who treat patients with cancer, as well as nurse practitioners and nurses. Physician assistants, pharmacists, researchers, and other health care professionals interested in the treatment of cancer are also invited to participate.
At the conclusion of this activity, you should be better prepared to:
- Compare the relative strengths and limitations of liquid biopsy against those of conventional tissue biopsy
- Identify the scientific foundations of liquid biopsy technology
- Contrast available and emerging testing technologies with respect to sensitivity, specificity, and clinical applications for patients with lung cancer
- Appraise clinical evidence pertaining to specific testing modalities that may help to individualize treatment protocols for patients with lung cancer
Faculty, Staff, and Planners' Disclosures
Benjamin Levy, MD
Clinical Director of Medical Oncology
Johns Hopkins Sidney Kimmel Cancer Center
Sibley Memorial Hospital
Disclosure: Consultant: Genentech, Eli Lilly, AstraZeneca, Celgene, BMS, Merck
Joshua Bauml, MD
Assistant Professor of Medicine
Division of Hematology/Oncology
Perelman School of Medicine
University of Pennsylvania
Disclosure: Grant Research Support: Merck, Clovis, Carevive Systems, Novartis, Bayer; Consultant: Clovis, BMS, AstraZeneca, Celgene, Boehringer Ingelheim, Merck, Guardant Health, Genentech
Hossein Borghaei, MS, DO
Chief, Thoracic Medical Oncology
Fox Chase Cancer Center
Disclosure: Grant Research Support: Celgene, Merck, Millennium; Consultant: BMS, Lilly, Genentech, Celgene, Pfizer, EMD-Serono, Trovagene
Stephen Liu, MD
Georgetown University Medical Center
Disclosure: Grant/Research Support: Bayer, Clovis, Corvus, Esanex, Genentech, Ignyta, Lycera, Medimmune, Merck, Oncomed, Pfizer, Threshold; Consultant: Ariad, AstraZeneca, Bristol-Myers Squibb, Celgene, Genentech, Ignyta, Lilly, Pfizer, Taiho, Takeda
The staff of Physicians' Education Resource®, LLC 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.
PER Pulse Recap™PER Pulse Recap (1 of 3)
This first of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on the role of tissue-based testing and challenges faced with this approach.
- In lung cancer, a tissue biopsy is the gold standard. This approach, however, does have potential drawbacks, including increased expenditures from adverse events or complications during biopsy. A retrospective analysis from a Medicare database of 8979 patients showed that a complication (eg, pneumothorax) could quadruple the cost of a biopsy from approximately $9,000 to approximately $38,000.
- An additional challenge with tissue biopsies is the possibility of insufficient tissue obtained. A study of 102 patients at the University of Pennsylvania showed that tissue-based molecular testing was successful in only half of the patients, most often because of a lack of tissue.
- Given that cell-free DNA can be detected in patients with cancer, this raises the possibility of a less invasive approach to analyze tumor DNA.
PER Pulse Recap (2 of 3)
This second of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on the sensitivity of plasma-based testing and clinical applications of plasma-based test results.
- An examination of plasma-based testing carried out by Oxnard et al showed that plasma-based testing had a sensitivity of 82% to 86% of that of tissue-based testing for the sensitizing exon 19 or exon 21 mutation in the epidermal growth factor receptor (EGFR), and the sensitivity was 70% for the T790M resistance mutation.
- Patients in this study who had progressed on a first-line EGFR inhibitor and who had a positive result, by plasma-based testing, for T790M had outcomes similar to those with a positive result from tissue-based testing. However, the outcome with a negative T790M result by plasma differed from the outcome in T790M-negative disease by tissue-based testing. Therefore, a true positive T790M result by plasma may be sufficient to recommend osimertinib; however, a negative result by plasma should be confirmed by tissue-based testing.
PER Pulse Recap (3 of 3)
This third of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on first-line epidermal growth factor receptor inhibition and the sensitivity of plasma-based testing in this setting.
- The phase III FLAURA trial compared osimertinib to erlotinib or gefitinib as first-line therapy in patients with EGFR mutation–positive lung cancer and led to approval of osimertinib in this setting based on superior progression-free survival with osimertinib.
- Comparison of tissue-based and plasma-based molecular testing was also carried out in the FLAURA trial. The concordance between tissue- and plasma-based testing was 87% for the exon 19 deletion and 88% for the exon 21 L858R point mutation.
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