Oncology Briefings™: Managing Pneumonitis in Patients with Stage III NSCLC

Release Date: December 30, 2018
Expiration Date: December 30, 2019
Media: Internet - based

Activity Overview

This activity, Oncology Briefings™: Managing Pneumonitis in Patients with Stage III NSCLC, developed in Physicians’ Education Resource, LLC^® established Oncology Briefings™ legacy format, is an online interactive monograph that provides treatment strategies for patients with pneumonitis secondary to non-small cell lung cancer (NSCLC). This presentation features a national thought leader, Roy S. Herbst, MD, PhD, who provides key insights.

Benefits of Participating

• Learn about new standards of care for the treatment of immune checkpoint inhibitor (ICPi)–induced pneumonitis in NSCLC
• Find out how experts diagnose and manage ICPi-induced pneumonitis
• Gain insight into emerging therapies for predicting patients at high risk of developing pneumonitis and prevention strategies

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca Pharmaceuticals LP.

Target Audience

This educational initiative is directed toward oncology healthcare professionals involved in the treatment and management of patients with non-small cell lung cancer (NSCLC), including medical oncologists, surgical oncologists, and pulmonologists. Fellows, nurses, nurse practitioners, physician assistants, and other healthcare professionals interested in the management of patients with NSCLC are also invited to participate.

Learning Objectives

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

• Determine how multidisciplinary team approaches can be promulgated to identify pneumonitis in patients with stage III NSCLC
• Characterize pneumonitis in the context of the application of chemoradiotherapy and immune checkpoint inhibitor (ICPi) utilization in patients with lung cancer
• Apply clinical trial and practical experience with the use of ICPis in patients with NSCLC to optimize management

Faculty, Staff, and Planners' Disclosures

Faculty

Roy S. Herbst, MD, PhD
Ensign Professor of Medicine (Medical Oncology)
Professor of Pharmacology
Chief of Medical Oncology
Associate Director for Translational Research
Yale Cancer Center, Smilow Cancer Hospital
New Haven, CT

Disclosures: Consultant: AbbVie Pharmaceuticals, AstraZeneca, Biodesix, Bristol-Myers Squibb, Eli Lilly and Company, EMD Serono, Genentech/Roche, Heat Biologics, Jun Shi Pharmaceuticals, Loxo Oncology, Merck and Company, Nektar, NextCure, Novartis, Pfizer, Sanofi, Seattle Genetics, Shire PLC, Spectrum Pharmaceuticals, Symphogen, TESARO; Research Support: AstraZeneca, Eli Lilly and Company, Merck and Company; Scientific Advisory Board: Neon Therapeutics, Infinity Pharmaceuticals, NextCure

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^TM Recap
 
Prevalence and Risks of Checkpoint Inhibitor Pneumonitis
 
The online Oncology Briefings™ CME activity, Managing Pneumonitis in Patients With Stage III Non-Small Cell Lung Cancer, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving standards of care for the treatment of checkpoint inhibitor pneumonitis (CIP) in non-small cell lung cancer (NSCLC). Leading expert Roy S. Herbst, MD, PhD, Chief of Medical Oncology and Associate Director for Translational Research at Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT, answers key questions supported by the presentation of clinical science about CIP.
 
This first of 3 PER Pulse™ Recaps from the program focuses on prevalence of immune-related adverse events (irAEs) with immune checkpoint inhibitor (ICPi) therapy. Dr. Herbst discusses the benefits of ICPi therapy and risks of developing CIP, and explains the importance of early detection and diagnosis for the effective management of pneumonitis in the setting of NSCLC. Key takeaways include the following:

• The PACIFIC trial impacted clinical practice in the setting of stage III NSCLC, showing that ICPi therapy has benefited many patients. However, irAEs can occur, including thyroiditis, colitis, and pneumonitis. Most irAEs can effectively be treated with steroid therapy.

• Although ˂5% of patients will experience CIP, it can be fatal. It is important to monitor patients, keeping in mind that infiltrates may not be evident on x-rays despite symptoms, and conversely, CIP can be asymptomatic in the early stages, yet be evident on x-rays.

• There is uncertainty about why some patients develop CIP and others do not, but increased risk may be related to the nature of the disease itself, previous surgery or radiation, human leukocyte antigen (HLA) type, and other characteristics of the tumor.   

• The risk of CIP is 2 to 3 times higher with combination therapy, such as with programmed cell death 1 and/or its ligand (PD-1/PD-LI) inhibitors and cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors, and toxicities should be closely monitored.

 
2 of 3
PER Pulse^TM Recap
 
Diagnosing Checkpoint Inhibitor Pneumonitis
 
The online Oncology Briefings™ CME activity, Managing Pneumonitis in Patients With Stage III Non-Small Cell Lung Cancer, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving standards of care for the treatment of checkpoint inhibitor pneumonitis (CIP) in non-small cell lung cancer (NSCLC). Leading expert Roy S. Herbst, MD, PhD, Chief of Medical Oncology and Associate Director for Translational Research at the Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT, answers key questions supported by the presentation of clinical science about CIP.
 
This second of 3 PER Pulse™ Recaps from the program focuses on the diagnostic features, treatment strategies, and the importance of a multidisciplinary team when caring for patients being treated for NSCLC. Dr. Herbst explains that although it is challenging to distinguish between concurrent chemoradiation therapy (CCRT)–induced pneumonitis and CIP, there are features of each that can help to make the proper diagnosis. He also provides treatment strategies and a multidisciplinary approach for the treatment of CIP. Key takeaways from Dr. Herbst include the following:

• In CCRT pneumonitis, the pattern of inflammation will typically occur within the field of radiation, and inflammation occurring outside of the field can signify CIP. The molecular mechanisms underlying each are not fully understood.

• The onset of CCRT tends to be earlier, whereas there is a wider range of onset related to CIP, which can range from 2 months to 2 years. Symptoms of pneumonitis include nonproductive cough, dyspnea, fever, and chest pain.

• The grade of pneumonitis is very important and directs clinical decision-making. Most cases of pneumonitis (15%-20%) are grade 1 and 2, whereas 5% of patients will experience more-severe pneumonitis. Treatment ranges from delaying treatment and initiating steroid therapy to hospitalization and permanent cessation of immune therapy. 

• A multidisciplinary team should work closely together to monitor patients and communicate at all stages of a patient’s care, especially as adverse events arise. The team should consist of the oncologist, radiation oncologist, pulmonologist, rheumatologist, nurse practitioners, and other healthcare providers involved in the care of patients with NSCLC.

 
3 of 3
PER Pulse^TM Recap
 
Emerging Strategies for Treatment and Prevention of Pneumonitis
 
The online Oncology Briefings™ CME activity, Managing Pneumonitis in Patients With Stage III Non-Small Cell Lung Cancer, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving standards of care for the treatment of checkpoint inhibitor pneumonitis (CIP) in non-small cell lung cancer (NSCLC). Leading expert Roy S. Herbst, MD, PhD, Chief of Medical Oncology and Associate Director for Translational Research at the Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT, answers key questions supported by the presentation of clinical science about CIP.
 
This third and final of 3 PER Pulse™ Recaps from the program focuses on clinical trials investigating the prevention and treatment of pneumonitis. Dr. Herbst discusses studies investigating the prevention of pneumonitis, and shares his insights regarding strategies for targeting molecular mechanisms underlying the pathogenesis of pneumonitis. Key takeaways include the following:

• Imaging-based methods are being investigated for prevention of pneumonitis and to guide treatment plans. 4D computed tomography (4D CT) ventilation imaging and [18F]-2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) may help to identify patients at increased risk.

• Ongoing studies are determining whether various radiation techniques can minimize the amount of lung exposed.

• A clinical trial program for lung cancer is analyzing biopsied tissue to determine potential resistance mechanisms in the clinic for development of targeted therapy.

• Targets of interest include free-radical production, inflammatory cells, cytokine and growth factor expression, renin-angiotensin system inhibitors (RASis), and angiotensin-converting enzyme inhibitors (ACEis).