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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 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Merck Sharp & Dohme Corp.

Medical Crossfire®: Key Questions for the Use of Immunotherapy Throughout the Disease Continuum for NSCLC in an Era of Rapid Development

Release Date: September 29, 2017
Expiration Date: September 29, 2018
Media: Internet - based

 

Activity Overview

This online activity features an expert panel discussion of key data in lung cancer immunotherapy, including practice-changing data and commentary on the optimal duration of therapy, combination regimens, biomarkers, and the management of immune-related adverse events. Throughout the program, the experts provide their perspectives on the clinical application of these data and the future direction of immunotherapies within the lung cancer treatment landscape.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Merck Sharp & Dohme Corp.

CME Table of Contents

  • Introduction
  • Key Randomized Data With Immunotherapy in Lung Cancer
  • What is the Optimal Duration of Therapy?
  • Dual Immunotherapy Combinations
  • Emerging Perspectives on Biomarkers
  • Managing Immune-Related Adverse Events

Requirements for Successful Completion

  • You will need to login 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/video” will be available for your reference.
  • In order to receive a CME certificate, participants 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. Participants may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational activity is directed oncologists interested in the treatment of lung cancer. Nurse practitioners, physician assistants, nurses, and other healthcare professionals involved in the treatment and management of patients with lung cancer are also invited to participate.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  • Describe the mechanistic rationale for single agent and combination immunotherapeutic strategies in the management of advanced non–small cell lung cancer (NSCLC)
  • Evaluate findings from recent trials in the context of evolving immunotherapy treatment paradigms for patients with advanced NSCLC
  • Explain emerging perspectives on the use of biomarkers as a method to personalize care with the use of immunotherapeutic strategies
  • Apply best practices to proactively manage and mitigate the impact of treatment-related toxicities with the use of evolving immunotherapeutic combination approaches


Faculty, Staff, and Planners' Disclosures

Chair

Naiyer Rizvi, MD
Professor of Medicine
Director, Thoracic Oncology
Co-Director, Cancer Immunotherapy Program
Price Chair, Clinical Translational Research
Columbia University Medical Center
New York, NY

Disclosure: Consultant: Lilly, Bristol-Myers Squibb; Stock/Shareholder: Gritstone Oncology, ARMO Biosciences; Honoraria and/or Advisory Board: Roche, AztraZeneca, Novartis, Merck, and Pfizer.

Faculty

Leena Gandhi, MD, PhD
Director of Thoracic Medical Oncology
Associate Professor of Medicine
NYU Perlmutter Cancer Center
NYU Langone Medical Center
New York, NY

Disclosure: Disclosure: Consultant: SAB, Genentech, Merck, and Ignyta.

Justin F. Gainor, MD
Assistant Professor
Harvard Medical School
Assistant in Medicine
Massachusetts General Hospital
Boston, MA

Disclosure: Consultant: Pfizer, Bristol-Myers Squibb, Novartis, Genentech/Roche, Incyte, Ariad, and Merck.

Dr. Hossein Borghaei, DO, MS
Chief, Thoracic Medical Oncology
Fox Chase Cancer Center
Philadelphia, PA
 
 

Disclosure: Grant/Research Support: Millennium, Merck, Celgene; Consultant: Bristol-Myers Squibb, EMD Serono Inc., Lilly, Merck, Pfizer, Novartis, AstraZeneca, G-mab, Celgene, B.I., and Genentech.

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 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 education purposes only, and is not meant to substitute for the independent medical judgment of a physician or nurse relative to diagnostic, treatment, or management 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 activity.




PER Pulse™ Recap (1 of 3)
Updates on Immunotherapy in Metastatic NSCLC

Medical Crossfire®: Key Questions for the Use of Immunotherapy Throughout the Disease Continuum for NSCLC in an Era of Rapid Development highlighted key advances in lung cancer immunotherapy. The program chair, Naiyer Rizvi, MD, along with faculty, Hossein Borghaei, MS, DO; Justin F. Gainor, MD; and Leena Gandhi, MD, PhD, discussed key randomized trials of immunotherapy in lung cancer, combination therapy, duration of therapy, and biomarkers.

This first of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on updates to first-line immunotherapy in patients with metastatic, non–small cell lung cancer (NSCLC).

  • Results from the phase III KEYNOTE-024 trial, which compared single-agent pembrolizumab to standard platinum-based chemotherapy in patients with previously untreated disease, led to approval of this agent in patients with a PD-L1 expression level of ≥50%, regardless of histology. The primary endpoint, progression-free survival (PFS), was superior in the pembrolizumab arm (10.3 vs 6.0 months; HR, 0.50, P <.001). An update, reflecting an additional 14 months of follow-up after the original report, showed a median overall survival (OS) of 30.0 months with pembrolizumab compared with 14.2 months in the chemotherapy arm (HR, 0.63; P = .002).
  • Results from the phase II KEYNOTE-021 trial led to the accelerated approval of pembrolizumab with carboplatin/pemetrexed as first-line therapy in patients with metastatic lung adenocarcinoma, regardless of PD-L1 expression. Overall response, the primary endpoint, was superior in the triplet arm (57% vs 32%; P = .0029). Updated results presented in September 2017 showed an ongoing PFS advantage in the pembrolizumab arm (19.0 vs 8.9 months; HR, 0.54; P = .0067) and a trend toward improved OS. Phase III trials combining immunotherapy with chemotherapy are ongoing, including KEYNOTE-189, which is comparing pembrolizumab/platinum/pemetrexed with chemotherapy alone, and IMpower150, which is evaluating atezolizumab with chemotherapy.

To view the videos and expert commentary for this edition of Medical Crossfire®, please visit www.gotoper.com.




PER Pulse™ Recap (2 of 3)
Future Directions for Immunotherapy in NSCLC

Medical Crossfire®: Key Questions for the Use of Immunotherapy Throughout the Disease Continuum for NSCLC in an Era of Rapid Development highlighted key advances in lung cancer immunotherapy. The program chair, Naiyer Rizvi, MD, along with faculty, Hossein Borghaei, MS, DO; Justin F. Gainor, MD; and Leena Gandhi, MD, PhD, discussed key randomized trials of immunotherapy in lung cancer, combination therapy, duration of therapy, and biomarkers.

This second of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on combination immunotherapy and the expansion of immunotherapy into stage III non–small cell lung cancer (NSCLC).

  • Combination PD-L1 and CTLA-4 blockade has been explored in the first-line setting in patients with metastatic NSCLC. The phase I CheckMate 012 trial evaluated the combination of nivolumab and ipilimumab, yielding an overall response rate (ORR) of approximately 40% in the overall cohort. The phase III CheckMate 227 trial is ongoing to validate these results. A separate phase III trial, MYSTIC, is evaluating the combination of durvalumab and tremelimumab; this trial did not meet its primary endpoint of improved progression-free survival (PFS) compared with standard platinum-based chemotherapy, although the trial continues for the analysis of overall survival (OS).
  • In patients with unresectable stage III NSCLC who achieved a response after concurrent chemoradiation therapy, the phase III PACIFIC trial compared subsequent therapy with durvalumab with placebo. In the durvalumab arm, the co-primary endpoint of PFS was superior (16.8 vs 5.6 months; HR, 0.52; P <.001); ORR was also improved in the durvalumab arm. This trial continues to mature for the co-primary endpoint of OS. Based on these data, the Food and Drug Administration granted a breakthrough therapy designation to durvalumab.

To view the videos and expert commentary for this edition of Medical Crossfire®, please visit www.gotoper.com.




PER Pulse™ Recap (3 of 3)
Ongoing Questions With Immunotherapy in Lung Cancer

Medical Crossfire®: Key Questions for the Use of Immunotherapy Throughout the Disease Continuum for NSCLC in an Era of Rapid Development highlighted key advances in lung cancer immunotherapy. The program chair, Naiyer Rizvi, MD, along with faculty; Hossein Borghaei, MS, DO; Justin F. Gainor, MD; and Leena Gandhi, MD, PhD, discussed key randomized trials of immunotherapy in lung cancer, combination therapy, duration of therapy, and biomarkers.

This third of 3 PER Pulse™ Recaps from this Medical Crossfiresup>® focuses on the evolving issues of the optimal duration of therapy and selective biomarkers for immunotherapy.

  • The optimal duration of therapy for immunotherapy in non–small cell lung cancer (NSCLC) is still unknown. Initial data from the CheckMate 153 trial, which were presented in September 2017, suggest that a fixed duration of 1 year may yield inferior outcomes compared with continuous therapy. It should be noted, however, that efficacy was an exploratory endpoint in this trial. Furthermore, other durations of therapy, such as 2 years, were not assessed.
  • In NSCLC, PD-L1 is currently the only biomarker used, with expression cutoff points of ≥50% for first-line pembrolizumab and ≥1% for pembrolizumab, but not nivolumab or atezolizumab, in platinum-pretreated patients. Due to the variability of PD-L1 testing, other biomarkers are being explored. Tumor mutation burden (TMB) has been explored, based on the rationale that mutated proteins would mark a tumor cell as foreign to the immune system. An exploratory analysis of the phase III frontline CheckMate 026 trial was carried out; this trial had previously failed to show improved efficacy with nivolumab compared with platinum-based chemotherapy in patients with PD-L1–positive (≥5% or ≥50%) NSCLC. An analysis of the TMB was carried out, with patients divided into TMB-high, -medium, and -low cohorts. Although no benefit was seen in patients with a medium or low TMB, those with a high TMB showed a progression-free survival benefit with nivolumab compared with chemotherapy (9.7 vs 5.8 months; HR, 0.63). These exploratory data will require prospective validation, and trials are ongoing to further study TMB as a tool for selecting patients for immunotherapy.

To view the videos and expert commentary for this edition of Medical Crossfire®, please visit www.gotoper.com.








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