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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 AstraZeneca.

Online! Medical Crossfire®: How Do You Use Liquid Biopsies in NSCLC?


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

Activity Overview

Medical Crossfire®: How Do You Use Liquid Biopsies in NSCLC? will update oncology healthcare professionals involved in the treatment of patients with lung cancer on the application of liquid biopsies in multiple lines of therapy. In Module 1, we will discuss current approaches to molecular testing and ways to address challenges with tissue-based testing. Module 2 will provide an overview of clinical data on liquid biopsies, including the potential to identify additional targetable oncogenes beyond those found by tissue-based methods. In Module 3, we will discuss issues related to the interpretation of liquid-based biopsies. This activity will conclude in Module 4 with take-home messages from the expert faculty.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

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, pathologists, and fellows who treat patients with cancer. Nurse practitioners, nurses, physician assistants, pharmacists, investigators, and other healthcare professionals interested in the treatment of cancer will be invited to participate.

Learning Objectives

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

  1. Evaluate the relative strengths and limitations of liquid biopsy against those of conventional tissue biopsy.
  2. Describe the scientific foundations of liquid biopsy technology.
  3. Differentiate available and emerging testing technologies with respect to sensitivity, specificity, and clinical applications for patients with lung cancer.
  4. 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

Faculty

Benjamin P. Levy, MD
Clinical Director of Medical Oncology
Johns Hopkins Sidney Kimmel Cancer Center
Sibley Memorial Hospital
Washington, DC
 

Disclosures: Consultant: AstraZeneca, Celgene, Merck, Eli Lilly, Genentech, Takeda

Joshua Bauml, MD
Assistant Professor of Medicine
Division of Hematology/Oncology
Perelman School of Medicine
University of Pennsylvania
Staff Physician
Corporal Michael J. Crescenz VA Medical Center
Philadelphia, PA

Disclosures: Grant Research Support: Merck, Incyte, Carevive Systems, Novartis, Bayer, Janssen, AstraZeneca, Takeda; Consultant: Bristol-Myers Squibb, AstraZeneca, Celgene, Merck, Janssen, Genentech, Guardant Health, Boehringer Ingelheim, Takeda.

Sarah B. Goldberg, MD, MPH
Assistant Professor of Medicine (Medical Oncology)
Yale Cancer Center
New Haven, CT
 
 

Disclosures: Advisory Boards: AstraZeneca, Eli Lilly, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Amgen, Spectrum

Zofia Piotrowska, MD, MHS
Instructor of Medicine, Harvard Medical School
Assistant in Medicine, Massachusetts General Hospital
Boston, MA
 
 

Disclosures: Grant Research Support: AstraZeneca, Spectrum, Takeda; Consultant: AstraZeneca, Spectrum, Novartis, Guardant Health, Takeda, Novartis, AbbVie

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
PER Pulse Recap

Complementary Biopsy Sources for Molecular Testing
 
Medical Crossfire®: How Do You Use Liquid Biopsies in NSCLC? featured nationally recognized lung cancer experts discussing the optimization of molecular testing in lung cancer. The program chair, Benjamin Levy, MD, along with faculty, Joshua Bauml, MD; Sarah B. Goldberg, MD, MPH; and Zofia Piotrowska, MD, MHS, discussed challenges in obtaining sufficient biopsy material, the potential for liquid-based next-generation sequencing, and plasma-based testing upon disease progression.
 
This first of 3 PER Pulse Recaps from this Medical Crossfire® focuses on the challenges with tissue-based biopsies and the potential for liquid-based testing:

  • Tissue-based biopsies are considered the standard of care; however, a lack of sufficient tissue frequently occurs, leading to barriers to molecular testing. In a study carried out at the University of Pennsylvania, tissue-based sequencing was successful in only approximately half of the cases; insufficient tissue was the most common cause of testing failure.
  • Plasma-based testing may offer a less-invasive approach to obtaining genetic material for molecular testing. A prospective approach in 180 patients resulted in a turnaround time of 3 business days for plasma-based testing compared with 12 business days with tissue-based testing in patients with newly diagnosed lung cancer.
  • Initial application of plasma-based testing for detecting the T790M resistance mutation in patients receiving inhibitors of the epidermal growth factor receptor showed that plasma-positive results yielded similar responses to osimertinib as tissue-positive results; however, a negative result by plasma needed to be verified by tissue-based testing, due to a lower level of sensitivity in plasma-based testing in this application.


2 of 3
PER Pulse Recap

Next-Generation Sequencing From Liquid-Based Biopsies
 
Medical Crossfire®: How Do You Use Liquid Biopsies in NSCLC? featured nationally recognized lung cancer experts discussing the optimization of molecular testing in lung cancer. The program chair, Benjamin Levy, MD, along with faculty, Joshua Bauml, MD; Sarah B. Goldberg, MD, MPH; and Zofia Piotrowska, MD, MHS, discussed challenges in obtaining sufficient biopsy material, the potential for liquid-based next-generation sequencing (NGS), and plasma-based testing upon disease progression.
 
This second of 3 PER Pulse Recaps from this Medical Crossfire® focuses on the use of liquid-based biopsies for multigene testing in lung cancer:

  • A prospective study was carried out in 323 patients with metastatic lung cancer (approximately 50% each with newly diagnosed or progressive disease). This study aimed to determine if plasma-based NGS testing could identify additional oncogenic drivers compared with tissue-based testing.
  • In patients who underwent only tissue-based testing, targetable mutations were identified in 20.5% of patients. The addition of plasma-based NGS testing increased the proportion to 36% of patients.
  • Mutations were identified in a wide range of oncogenes, including EGFR, ALK, MET, BRCA1, ROS1, RET, ERBB2, and BRAF.


3 of 3
PER Pulse Recap

Plasma-Based Testing to Characterize Resistance to Targeted Therapy
 
Medical Crossfire®: How Do You Use Liquid Biopsies in NSCLC? featured nationally recognized lung cancer experts discussing the optimization of molecular testing in lung cancer. The program chair, Benjamin Levy, MD, along with faculty, Joshua Bauml, MD; Sarah B. Goldberg, MD, MPH; and Zofia Piotrowska, MD, MHS, discussed challenges in obtaining sufficient biopsy material, the potential for liquid-based next-generation sequencing, and plasma-based testing upon disease progression.
 
This third of 3 PER Pulse Recaps from this Medical Crossfire® focuses on the use of liquid biopsies to determine the mechanism of resistance to targeted therapy, with a focus on the epidermal growth factor receptor (EGFR) pathway:

  • Although EGFR-T790M is the dominant resistance mechanism to first- and second-generation EGFR inhibitors, resistance to third-generation agents, such as osimertinib, is still undergoing characterization.
  • To further elucidate the mechanisms of resistance to osimertinib, plasma biopsies were taken from patients enrolled in phase III trials of osimertinib; discussed here is the analysis of patients enrolled in the first-line FLAURA trial of osimertinib versus erlotinib or gefitinib. Paired samples taken at baseline and at progression/discontinuation were analyzed from both treatment arms.
  • As seen in previous analyses, the most common resistance mechanism to erlotinib or gefitinib was EGFR-T790M, observed in 47% of patients.
  • In patients with acquired resistance to osimertinib, MET amplification was observed in 15% of cases, with the caveat that liquid-based testing may not fully characterize gene amplification. Other mechanisms of resistance included the EGFR-C797S resistance mutation (7%), PIK3CA mutations (7%), BRAF mutations (3%), and HER2 amplification (2%).

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