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Cases from the Community: Clinical Investigators Provide Perspectives on Actual Patients with Metastatic Colorectal, Gastric and Pancreatic Cancer
Released May 2015

Proceedings from a CME symposium held at the 2015 Gastrointestinal Cancers Symposium. Featuring perspectives from Drs Dirk Arnold, Tanios Bekaii-Saab, Johanna C Bendell, Axel Grothey, Howard S Hochster and Philip A Philip. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists, hematology-oncology fellows, gastrointestinal surgeons and other healthcare providers involved in the treatment of gastrointestinal (GI) cancers.

    OVERVIEW OF ACTIVITY
    Cancer of the colon and rectum is the fourth most frequently diagnosed cancer and the second most common cause of death among all neoplasms in the United States, accounting for approximately 9% of all cancer deaths. Although individually less frequently encountered, the collection of other noncolorectal GI cancers account for more per annum cancer-related deaths than those attributed to tumors of the colon and rectum combined. In 2014 in the United States alone it is estimated that these diseases culminated in 136,830 new cases and 50,310 deaths.

    Current therapeutic management of colorectal cancer (CRC) is dependent on tumor stage at the time of initial diagnosis, status of surgical margins, patient performance status, age, prior treatment exposure and sites of metastasis for those with disease recurrence or de novo advanced cancer. Although these variables are helpful in guiding selection of treatment, the introduction of novel biomarkers, multigene signatures and molecular-targeted systemic agents has significantly refined the clinical algorithm such that individualized therapeutic approaches have become the standard. Similarly, local and systemic treatment approaches for each of the non-CRC GI cancers are continuously evolving. Like their more prevalent tumor counterparts, the impact of novel molecular-targeted and biologic therapies on the management of non-CRC GI cancers has been profound. By providing information on the latest research developments and their potential application to routine practice, this activity is designed to assist medical oncologists, hematology-oncology fellows, gastrointestinal surgeons and other healthcare providers with the formulation of up-to-date clinical management strategies for both CRC and select non-CRC GI cancers.

    LEARNING OBJECTIVES

    Upon completion of this activity, participants should be able to:
    • Coordinate comprehensive biomarker analysis for patients diagnosed with advanced CRC, and use this information to guide evidence-based care.
    • Communicate the benefits and risks of approved anti-VEGF, anti-EGFR and other targeted biologic therapies to patients with metastatic CRC, and develop an evidence-based algorithm to sequence available options based on disease- and patient-specific characteristics.
    • Individualize local and systemic treatment for patients with metastatic CRC that is isolated to the liver.
    • Appreciate the recent FDA-approved indications for ramucirumab in advanced gastric or gastroesophageal junction cancer, and discern how this agent can be optimally integrated into clinical practice for patients with HER2-negative and HER2-positive disease.
    • Implement a clinical plan for the management of advanced HER2-positive gastric cancer, incorporating existing and emerging targeted treatments.
    • Appraise the rationale for and clinical data with investigational anti-PD-1 and/or anti-PD-L1 antibodies in patients with gastric cancer.
    • Consider age, performance status and other clinical factors in the selection of systemic therapy for patients with metastatic pancreatic adenocarcinoma.
    • Describe the mechanism of action of and available research data with ruxolitinib in pancreatic cancer, and use this information to counsel appropriate patients regarding ongoing trials evaluating this novel approach.
    • Recall new data with other investigational agents demonstrating promising activity in colorectal, gastric and pancreatic cancers.

    ACCREDITATION STATEMENT

    CME credit is no longer available for this issue

    CREDIT DESIGNATION STATEMENT

    CME credit is no longer available for this issue

    HOW TO USE THIS CME ACTIVITY
    This activity consists of a video component. The participant should watch the video.


    CME credit is no longer available for this issue

    CONTENT VALIDATION AND DISCLOSURES
    Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CME activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

    FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Dirk Arnold, MD
    Director
    Department, Medical Oncology
    Klinik fuer Tumorbiologie
    Freiburg, Germany

    Advisory Committee: Amgen Inc, Bayer HealthCare Pharmaceuticals, EMD Serono Inc, Roche Laboratories Inc; Consulting Agreement: Sanofi; Contracted Research: EMD Serono Inc, Roche Laboratories Inc; Speakers Bureau: Bayer HealthCare Pharmaceuticals, EMD Serono Inc, Roche Laboratories Inc.

    Tanios Bekaii-Saab, MD
    Section Chief, Gastrointestinal Oncology
    Chair, OSUCCC Gastrointestinal Disease Research Group
    Professor of Medicine and Pharmacy
    The Ohio State University – James Cancer Hospital
    Columbus, Ohio

    Consulting Agreements: Amgen Inc, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Lilly, Pfizer Inc, Taiho Oncology Inc; Contracted Research: Oncolytics Biotech Inc; Other Remunerated Activities: Exelixis Inc, Polaris Group.

    Johanna C Bendell, MD
    Director, GI Oncology Research
    Associate Director, Drug Development Unit
    Sarah Cannon Research Institute
    Nashville, Tennessee

    No real or apparent conflicts of interest to disclose.

    Axel Grothey, MD
    Professor of Oncology
    Department of Medical Oncology
    Mayo Clinic
    Rochester, Minnesota

    Contracted Research: Bayer HealthCare Pharmaceuticals, Eisai Inc, Genentech BioOncology, Lilly, Pfizer Inc, Sanofi.

    Howard S Hochster, MD
    Associate Director (Clinical Research)
    Yale Cancer Center
    Professor of Medicine
    Yale School of Medicine
    New Haven, Connecticut

    Advisory Committee: Bayer HealthCare Pharmaceuticals, Genentech BioOncology; Consulting Agreements: Bayer HealthCare Pharmaceuticals, Genentech BioOncology, Genomic Health Inc, Roche Laboratories Inc, Sanofi; Speakers Bureau: Genomic Health Inc.

    Philip A Philip, MD, PhD
    Professor of Oncology and Medicine
    Director of GI and Neuroendocrine Tumors
    Vice President of Medical Affairs
    Karmanos Cancer Institute
    Wayne State University
    Detroit, Michigan

    Advisory Committee: Amgen Inc, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals, an Amgen subsidiary; Consulting Agreements: Amgen Inc, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Genomic Health Inc, Lilly, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals, an Amgen subsidiary, Roche Laboratories Inc, Sanofi; Contracted Research: Amgen Inc, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Celgene Corporation, Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals, an Amgen subsidiary, Roche Laboratories Inc, Sanofi; Speakers Bureau: Amgen Inc, Bayer HealthCare Pharmaceuticals, Celgene Corporation, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals, an Amgen subsidiary, Roche Laboratories Inc, Sanofi.

    CONSULTING MEDICAL ONCOLOGISTS — The following consulting medical oncologists (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Lowell L Hart, MD
    Scientific Director of Clinical Research
    Director, Drug Development Program
    Florida Cancer Specialists
    Fort Myers, Florida

    Contracted Research: Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation; Speakers Bureau: Genentech BioOncology, Novartis Pharmaceuticals Corporation.

    Neil I Morganstein, MD
    Chair of Leukemia/Lymphoma Board
    Carol G Simon Cancer Center
    Overlook Medical Center
    Summit, New Jersey

    No real or apparent conflicts of interest to disclose.

    Erik J Rupard, MD
    Chief, Section of Hematology-Oncology
    McGlinn Cancer Institute
    The Reading Hospital and Medical Center
    Reading, Pennsylvania

    No real or apparent conflicts of interest to disclose.

    MODERATORDr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Amgen Inc, Astellas Scientific and Medical Affairs Inc, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Myriad Genetic Laboratories Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Teva Oncology, Tokai Pharmaceuticals Inc and VisionGate Inc.

    RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

    This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

    This activity is supported by educational grants from Bayer HealthCare Pharmaceuticals, Boston Biomedical Pharma Inc, Genentech BioOncology, Incyte Corporation, Lilly, Sirtex Medical Ltd and Taiho Oncology Inc.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
    Adobe Flash Player 10.2 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Last review date: May 2015
    Expiration date: May 2016

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