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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 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 Merck Sharp & Dohme Corp.

Medical Crossfire®: How Can We Optimize Outcomes in Head and Neck Cancers with Immunotherapeutic Strategies?

Release Date: October 31, 2018
Expiration Date: October 31, 2019
Media: Internet - based
 

Activity Overview

Head and neck cancer (HNC) accounts for about 4% of all cancers in the United States. An estimated 64,690 people (47,650 men and 17,040 women) will develop HNC this year alone. While younger people can develop the disease, most people are older than age 50 years when they are diagnosed. Approximately 13,740 deaths (10,250 men and 3490 women) from HNC will occur this year.

Recognition of the role of human papillomavirus (HPV) in the development of oropharyngeal cancer (OPC) that has distinctly different clinical and molecular features (HPV-positive) than those of OPC not caused by HPV (HPV-negative) has had a tremendous impact on research in this field. Recognition of the fact that patients with HPV-positive cancer have better outcomes has led to concerns that current treatments, based mainly on findings from trials of HPV-negative HNC, may be more intensive than is necessary for patients with HPV-positive disease. These concerns, in turn, have paved the path for various clinical trials that focus on deintensification of therapies for specific subsets of patients with HNC.

In general, HNC treatment is evolving at a rapid pace due to our emerging understanding of the role of tumor-cell escape mechanisms. It is now well recognized that tumor cells evade recognition and destruction by the immune system by exploiting regulatory mechanisms, including immune checkpoint (ICP) pathways. The ability of cancer cells to evade ICPs creates an immunosuppressive microenvironment that enables the downregulation of T-cell activation and cell signaling. Novel ICP-blocking antibodies that are currently under development modulate T-cell pathways and have the potential to restore an antitumor immune response. Some of the most well-understood immuno-oncology (I-O) strategies involve targets that include cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1), and programmed death ligand 1 (PD-L1).

Indeed, ICP inhibition is the mechanism currently at the center of I-O drug development, such as agents targeting PD-1 and PD-L1. The PD-1 inhibitors nivolumab and pembrolizumab are currently approved for use in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC); the PD-L1 inhibitor durvalumab is also undergoing clinical trial evaluation for HNSCC. The anti-CTLA-4 compounds ipilimumab and tremelimumab have also been a focus of ongoing research in a number of solid tumors, including HNSCC. Checkpoint inhibition has become one of the most exciting areas in the field of I-O strategies that are poised to continue to evolve in clinical practice for HNSCC treatment in the very near future.

Ultimately, how I-O agents can be combined with one another or with other classes of drugs may further optimize outcomes for patients with advanced solid tumors. The evolving science on the use of biomarker testing continues to be a hot topic in the field because this may allow clinicians to personalize care in the treatment of solid tumors that include HNSCC. Importantly, our ability to practically apply I-O combinations in the clinic, and to optimize safety with proactive mitigation of predictable treatment-related toxicity, are key clinical priorities to improve care for our patients with some of the most difficult-to-treat advanced forms of HNSCC.

The management of HNC is evolving rapidly as newer therapeutic strategies based on a patient’s HPV status continue to emerge. Additionally, improved understanding of the new immune escape pathways offers the prospect of having a major impact on the management and outcomes of patients with HNC. There is an emerging need for clinicians to understand more about immune-therapeutic targets in order to be able to more accurately predict how various tumors will behave, and to tailor treatment appropriately for each patient.

Key practice gaps regarding the role of I-O therapy for clinicians involved in the treatment of patients with cancer have been identified based on expert opinions, surveys of practicing oncologists, emerging data for novel treatment options, and ongoing clinical studies investigating novel treatment regimens.

Acknowledgment of Commercial Support

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

Instructions for This Activity and Receiving Credit

  • 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 files” 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 program is directed toward medical oncologists interested in the diagnosis and treatment of head and neck squamous cell carcinoma (HNSCC). Surgical and radiation oncologists, endocrinologists, nurse practitioners, physician assistants, nurses, and other healthcare professionals interested in the treatment and management of patients with HNSCC are also invited to participate.

Learning Objectives

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

  • Discuss the rationale and evolving strategies for treatment deintensification in head and neck squamous cell carcinoma (HNSCC)
  • Describe how the immune system can be harnessed to treat cancer and the mechanistic rationale for the application of checkpoint inhibition strategies to target specific solid tumors
  • Evaluate clinical trial findings on immuno-oncology strategies in development for the treatment of HNSCC
  • Discuss emerging methods to personalize care with immuno-oncology strategies via the use of biomarkers and proactive mitigation and management of immune-related adverse events (irAEs)
  • Discuss how new evidence concerning immuno-oncology strategies should be placed in the context of current treatment standards and emerging combination strategies in clinical development for the treatment of HNSCC

Faculty, Staff, and Planners' Disclosure

Moderator

Ezra Cohen, MD, FRCPSC, FASCO
Professor, Division of Hematology/Oncology,
Department of Medicine, UC San Diego
Co-Director, San Diego Center for Precision Immunotherapy
Associate Director, Translational Science
UC San Diego Moores Cancer Center
Co-Leader, Solid Tumor Therapeutics Program
Co-Director, Head and Neck Cancer Center of Excellence
San Diego, CA

Disclosure: Consultant: Eisai, Pfizer, Merck, AstraZeneca, Bristol-Myers Squibb

Faculty

Barbara Burtness, MD
Professor of Medicine
Yale School of Medicine
Co-Leader, Developmental Therapeutics Program
Yale Cancer Center
New Haven, CT

Disclosure: Grant/Research Support: Advaxis, Merck, Debiopharm, Formation Biologics, BMS; Consultant: Bayer, Genentech, AstraZeneca, Bristol-Myers Squibb, Merck, Celgene, Alligator Bioscience

Luc Morris, MD
Surgeon and Catherine and Frederick Adler Chair for Junior Faculty
Associate Director, Immunogenomics and Precision Oncology Platform
Director, Fellowship Training
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosure: No relevant financial relationships with commercial interests to disclose.

David Raben, MD
Professor of Radiation Oncology
Department of Radiation Oncology
University of Colorado Anschutz Medical Campus
Denver, CO
 

Disclosure: Consultant: AstraZeneca; Ad Boards: AstraZeneca, Nanobiotix, Merck, EMD Serono, 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

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 and nursing education purposes only, and is not meant to substitute for the independent clinical 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®.







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