Accreditation/Credit Designation

Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education 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.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Bristol-Myers Squibb.

Online! Live Medical Crossfire®: Evaluating Immuno-Oncology Strategies Across Tumor Types


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

Activity Overview

Immune checkpoint inhibitors represent an entirely new treatment modality in the fight against cancer. These therapies, which harness the body’s own immune system to eradicate tumor cells, are transforming outcomes across an increasingly broad range of malignancies and making long-term survival a reality where, until recently, prognoses were poor.

In order to help you gain a better understanding of the mechanisms of action of these new therapies, and remain apprised of emerging evidence across tumor types so that you can appropriately integrate these agents into the management of your patients and improve outcomes, we have developed a dynamic Medical Crossfire® program. In this activity, leading clinical experts in melanoma, lung cancer, and genitourinary malignancies share their perspectives on the latest data and factors that may change your clinical practice. This exchange of ideas will explore the integration of immune checkpoint inhibitors into treatment algorithms for relevant malignancies, provide insights regarding the evolution of biomarkers for tailoring patient selection, and discuss the management of class-specific adverse events, giving you the opportunity to assess the opinions of multidisciplinary experts and optimize your approach to applying clinical evidence to real-world clinical scenarios.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Bristol-Myers Squibb.

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 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 activity is intended for medical oncologists, hematologists, and fellows who treat patients with cancer. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of cancer are also invited to participate.

Learning Objectives

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

  • Describe the changing role of immunotherapies for cancer management in the context of mechanistic characteristics and logical combination approaches
  • Relate findings from clinical trials with immunotherapies across multiple lines of therapy and tumor types, as well as key ongoing clinical trials in the field
  • Recognize evolving roles for biomarkers in the context of applying immunotherapeutic approaches to the treatment of cancer
  • Describe appropriate management strategies for management and mitigation of both rarely and commonly encountered adverse events from immunotherapies

Faculty, Staff, and Planners' Disclosures

Faculty

Toni K. Choueiri
Toni K. Choueiri, MD
Director, Lank Center for Genitourinary Oncology
Director, Kidney Cancer Center
Senior Physician, Dana-Farber Cancer Institute
Associate Professor of Medicine, Harvard Medical School
Boston, MA

Disclosures: Grant Research Support: All money to institution: Pfizer, GSK, Novartis, BMS, Merck, Exelixis, Roche, AstraZeneca, Tracon, Peloton, Celldex, Foundation Medicine, Calithera, Takeda; Consultant: AstraZeneca, Alligent, Alexion, Sanofi/Aventis, Bayer, BMS, Cerulean, Eisai, Foundation Medicine, Exelixis, Genentech, Roche, GlaxoSmithKline, Merck, Novartis, Peloton, Pfizer, Prometheus Labs, Corvus, Ipsen, Up-to-Date, NCCN, Analysis Group; Speakers Bureau: AstraZeneca, Clovis, Janssen/ Johnson & Johnson, Roche/ Genentech, Tesaro Inc.

Jason J. Luke
Jason J. Luke, MD, FACP
Assistant Professor of Medicine
The University of Chicago Medicine
Chicago, IL

Disclosures: Grant Research Support: AbbVie, Array, Boston Biomedical, Bristol-Myers Squibb, Celldex, CheckMate, Corvus, Delcath, Five Prime, Genentech, Immunocore, Incyte, MedImmune, MacroGenics, Novartis, Pharmacyclics, Palleon, Merck, Tesaro; Speakers Bureau: 7 Hills, Aduro, Actym, Alphamab Oncology, Amgen, Array, AstraZeneca, BeneVir, Bristol-Myers Squibb, Castle, CheckMate, Compugen, EMD Serono, Gilead, Ideaya, Janssen, Merck, NewLink, Novartis, RefleXion, Spring Bank, Syndax, Tempest, WntRx; Other: Array, AstraZeneca, BeneVir, Bristol-Myers Squibb, Castle, CheckMate, EMD Serono, Gilead, Ideaya, Janssen, Merck, NewLink, Novartis, RefleXion.

Roman Perez-Soler
Roman Perez-Soler, MD
Chairman, Department of Oncology
Montefiore Medical Center
Professor of Medicine
Chief, Division of Medical Oncology, Department of Medicine
Deputy Director, Albert Einstein Cancer Center
Bronx, NY

Disclosures: Grant Research Support: National Cancer Institute; Consultant: Glaxo, AstraZeneca, Clovis, Roche/Genentech, Boehringer Ingelheim, Lilly, Adgero; Shareholder: Adgero, Stelexis.

Daniel P. Petrylak
Daniel P. Petrylak, MD
Professor of Medicine (Medical Oncology) and Urology
Director, Prostate and GU Medical Oncology
Director, Prostate Cancer Translational Research Group
Yale Cancer Center
New Haven, CT

Disclosures: Grant Research Support: Agensys, AstraZeneca, Bayer, Clovis, Dendreon, Eli Lilly, Endocyte, Genentech, Innocrin, Johnson & Johnson, Lilly, MedImmune, Medivation, Merck, Millennium, Novartis, Pfizer, Progenics, Roche Laboratories, Sanofi Aventis, Sotio; Consultant: Astellas, AstraZeneca, Bayer, Bellicum, Dendreon, Exelixis, Ferring, Johnson & Johnson, Lilly, Medivation, Millennium, Pfizer, Roche Laboratories, Sanofi, Aventis; Shareholder: Bellicum, Tyme

The staff of 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 and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician 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®.

PER Pulse™ Recaps

1 of 3
Understanding How Immunotherapies Differ From Conventional Anticancer Treatments

 
Medical Crossfire®: Evaluating Immuno-Oncology Strategies Across Tumor Types is designed to help you gain a better understanding of the mechanisms of action of these new therapies, and to update you on emerging evidence across tumor types so that you can appropriately integrate these agents into the management of your patients. This activity features leading clinical experts in melanoma, lung cancer, and genitourinary malignancies, including Toni K. Choueiri, MD; Jason J. Luke, MD; Roman Perez-Soler, MD; and Daniel Petrylak, MD. Through a lively exchange of ideas, the faculty shared their perspectives on the latest data, how they integrate immune checkpoint inhibitors into treatment algorithms for relevant malignancies, and how they apply clinical evidence to real-world clinical scenarios.
 
This first of 3 PER Pulse™ Recaps focuses on the differences between immunotherapies, particularly immune checkpoint inhibitors, and conventional cytotoxic chemotherapy with regard to tumor response and adverse events. Highlights include:

  • In contrast to conventional cytotoxic or targeted anticancer agents which act directly to kill cancer cells, immunotherapies work by harnessing the immune system to attack the tumor.
  • The phenomenon of pseudoprogression is relatively rare (<10%). It is characterized by infiltration of the tumor by lymphocytes, which causes the tumor to look bigger on imaging scans. Clinical assessment of the patient and changes in their symptoms is necessary in this scenario, to determine the most appropriate management strategy.
  • While there are specific immune-related adverse events (irAEs) that clinicians need to be aware of, the AE profiles of immune checkpoint inhibitors are generally better than those of most cytotoxic chemotherapies and even many targeted agents.
    • irAEs may still occur after treatment has been discontinued, due to the half-life of the antibodies.
  • Aggressive treatment of irAEs is recommended, beginning with corticosteroids and if there is no improvement, rapidly moving to infliximab.
    • Once started, steroid treatment must be tapered slowly, over at least a month.
    • Although there was initially concern that the use of corticosteroids for the treatment of irAEs might reduce the effectiveness of immune checkpoint inhibitors, an accumulating body of evidence suggests that aggressive management has no negative effect on long-term efficacy outcomes.

2 of 3
Immune Checkpoint Inhibition – Paradigm-Changing Trials Across Tumor Types


Medical Crossfire®: Evaluating Immuno-Oncology Strategies Across Tumor Types is designed to help you gain a better understanding of the mechanisms of action of these new therapies, and to update you on emerging evidence across tumor types so that you can appropriately integrate these agents into the management of your patients. This activity features leading clinical experts in melanoma, lung cancer, and genitourinary malignancies, including Toni K. Choueiri, MD; Jason J. Luke, MD; Roman Perez-Soler, MD; and Daniel Petrylak, MD. Through a lively exchange of ideas, the faculty shared their perspectives on the latest data, how they integrate immune checkpoint inhibitors into treatment algorithms for relevant malignancies, and how they apply clinical evidence to real-world clinical scenarios. 

This second of 3 PER Pulse™ Recaps focuses on results from pivotal clinical trials that have established immune checkpoint inhibitors as standard-of-care treatment options for metastatic melanoma, lung cancer, bladder cancer, and renal cell carcinoma. Highlights include:

  • Melanoma
    • Data from the phase III CheckMate 067 trial comparing nivolumab ± ipilimumab with ipilimumab alone. Results showed that both nivolumab alone and nivolumab plus ipilimumab significantly improved response rates and progression-free survival (PFS) compared with single-agent ipilimumab (P <.001 for all comparisons).
    • The KEYNOTE-006 trial demonstrated that pembrolizumab was superior to ipilimumab with respect to response rate, PFS, and overall survival (OS).
  • Lung Cancer
    • In the first-line setting, results from the phase III KEYNOTE-024 trial in patients with metastatic non–small cell lung cancer (NSCLC; squamous or nonsquamous; mutation-negative) support the use of pembrolizumab specifically in patients with PD-L1 expression levels ≥50%, based on an OS advantage compared with platinum-based chemotherapy (HR, 0.60; P = .005).
    • Phase III trials have also shown that the addition of pembrolizumab (KEYNOTE-189) or atezolizumab (IMpower150) to first-line platinum-based chemotherapy significantly improves OS, regardless of PD-L1 status.
    • For patients with stage III, unresectable NSCLC that does not progress after concurrent chemoradiotherapy, results of the phase III PACIFIC trial showed that durvalumab significantly prolonged median OS compared with placebo (HR, 0.68; P = .0025). Median PFS was also significantly longer with durvalumab.
    • For patients with small cell lung cancer, results from the IMpower133 trial set a new standard of care. This first-line trial comparing etoposide/carboplatin/placebo with etoposide/carboplatin/atezolizumab showed a significant improvement in both PFS and OS with inclusion of the immune checkpoint inhibitor.
  • Bladder Cancer
    • In the phase III KEYNOTE-045 trial comparing pembrolizumab with chemotherapy as second-line therapy in patients who previously received platinum-based chemotherapy, pembrolizumab significantly prolonged OS (10.3 vs 7.4 months; P = .002).
    • The IMvigor211 trial compared second-line atezolizumab versus chemotherapy in platinum-pretreated patients. Results showed no difference in median OS between arms, but atezolizumab was associated with a more favorable safety profile and longer durations of response.
    • Phase II trials have demonstrated the activity of pembrolizumab and atezolizumab as first-line therapy for cisplatin-ineligible patients. However, in May 2018 the US FDA issued a safety warning, indicating that emerging data from ongoing first-line trials with pembrolizumab or atezolizumab monotherapy (KEYNOTE-361 and IMvigor130) suggest decreased survival compared with platinum-based chemotherapy.
      • Current expert guidelines recommend first-line treatment with an immune checkpoint inhibitor only for cisplatin-ineligible patients if the tumor is PD-L1–positive. Standard chemotherapy or a clinical trial is advised if the tumor is PD-L1–negative.
      • PD-L1 testing is not required for platinum-pretreated patients receiving treatment with an immune checkpoint inhibitor in the second-line setting.
  • Renal Cell Carcinoma (RCC)
    • The phase III Checkmate 214 trial compared nivolumab/ipilimumab versus sunitinib first-line for previously untreated advanced clear cell RCC. Median OS was not reached with nivolumab plus ipilimumab versus 26.0 months with sunitinib (HR, 0.63; P <.001). A significant OS benefit was observed irrespective of PD-L1 status, although benefit was greater in the PD-L1 ≥1% subgroup (HR, 0.45) than in the PD-L1 <1% subgroup (HR, 0.73).
    • The phase III CheckMate 025 comparing nivolumab versus everolimus in patients with clear cell RCC previously treated with ≥1 prior lines of therapy showed a significant OS benefit with the immune checkpoint inhibitor (HR, 0.73; P = .002), and this benefit was consistent across all baseline factors.


3 of 3
The Evolving Immunotherapy Biomarker Landscape


Medical Crossfire®: Evaluating Immuno-Oncology Strategies Across Tumor Types is designed to help you gain a better understanding of the mechanisms of action of these new therapies, and to update you on emerging evidence across tumor types so that you can appropriately integrate these agents into the management of your patients. This activity features leading clinical experts in melanoma, lung cancer, and genitourinary malignancies, including Toni K. Choueiri, MD; Jason J. Luke, MD; Roman Perez-Soler, MD; and Daniel Petrylak, MD. Through a lively exchange of ideas, the faculty shared their perspectives on the latest data, how they integrate immune checkpoint inhibitors into treatment algorithms for relevant malignancies, and how they apply clinical evidence to real-world clinical scenarios. 

This third of 3 PER Pulse™ Recaps focuses on patient selection for immune checkpoint inhibitor therapy, and the evolving role of biomarkers. Highlights include:

  • The value, or relevance, of PD-L1 as a biomarker to select patients for immune checkpoint inhibitor therapy appears to be dependent on tumor type.
  • Factors that can impact PD-L1 status include biopsy site and method, tumor heterogeneity, assay methodology and reagents, and immune system status at the time of the biopsy.
    • In addition, location of the PD-L1+ lymphocytes at the invasive edge of the tumor versus elsewhere may impact sensitivity to treatment.
  • Microsatellite instability (MSI) increases the rate of genomic mutations, which produces more neo-antigens, making the tumor more visible to the immune system. MSI-high status has been shown to be a robust predictor of sensitivity to immune checkpoint inhibitors across tumor types, and has been approved as a histology-independent biomarker for patient selection.

Login or Register to Start Activity

Please use the form below to Register or Log In to begin Activity.

*Required Fields
Calendar of Events
SUNMONTUESWEDTHURSFRISAT
    123
45678910
11121314151617
18192021222324
25262728293031
Filter By