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Real-Life Decisions: Clinical Investigators Provide Their Perspectives on Actual Patients with Metastatic Colorectal, Gastric and Pancreatic Cancer — A Special Roundtable Supplement
Released July 2016

A special supplement to a CME symposium held at the 2016 Gastrointestinal Cancers Symposium featuring expert comments on the application of emerging research to patient care. Featuring perspectives from Drs Tanios Bekaii-Saab and Heinz-Josef Lenz. (Video Program)

CE Disclosures and Faculty Information

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

    OVERVIEW OF ACTIVITY
    Local and systemic treatment approaches for GI cancers are continuously evolving. The impact of novel molecular-targeted and biologic therapies on the management of GI cancers has been profound and in several instances has changed best-practice care. In noncolorectal (non-CRC) GI cancers, late-stage clinical trials have demonstrated exciting results with an array of novel agents that are poised for integration into existing treatment algorithms. Also, a recent rapid expansion of novel biomarkers, multigene signatures and molecular-targeted systemic agents has significantly refined the clinical algorithm such that individualized therapeutic approaches have become standard for patients with colorectal cancer (CRC). This rapid paradigm shift presents a challenge to practicing oncologists who must grapple with the presentation of ambiguous data sets and their immediate impact on treatment decisions.

    In addition to maintaining a sound understanding of the conventional but distinct treatment algorithms applicable to CRC and each subtype of non-CRC GI cancers, practicing oncologists must now rationally integrate targeted agents into their individualized therapeutic recommendations for the safe and effective clinical management of these diseases. By providing information on the latest research developments and their potential application to routine practice, this activity is designed to assist medical oncologists, surgeons and other healthcare providers with the formulation of up-to-date clinical management strategies for CRC and various non-CRC GI cancers.

    LEARNING OBJECTIVES

    • Develop a long-term treatment plan for individuals diagnosed with advanced CRC, considering the patient’s biomarker profile, exposure to prior systemic therapy, symptomatology, performance status and treatment goals.
    • Discuss the use of HER2 status and clinical factors to optimize the selection and sequence of systemic therapy for locally advanced or metastatic gastric/gastroesophageal cancer.
    • Consider age, performance status and other clinical and logistical factors in the selection of systemic therapy for patients with locally advanced or metastatic pancreatic cancer.
    • Recognize the recent FDA approvals of TAS-102 for metastatic CRC and nal-IRI (MM-398) for metastatic pancreatic cancer, and discuss strategies to safely incorporate these agents into current clinical algorithms.
    • Review new data on investigational agents demonstrating promising activity in colorectal, gastric/gastroesophageal and pancreatic cancer.
    • Discuss the role of immune checkpoint inhibitors in the management of GI cancers.

    ACCREDITATION STATEMENT
    Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    CREDIT DESIGNATION STATEMENT
    Research To Practice designates this enduring material for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) — MAINTENANCE OF CERTIFICATION (MOC)
    Successful completion of this CME activity enables the participant to earn up to 2.5 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Please note, this program has been specifically designed for the following ABIM specialty: medical oncology.

    Personal information and data sharing: Research To Practice aggregates deidentified user data for program-use analysis, program development, activity planning and site improvement. We may provide aggregate and deidentified data to third parties, including commercial supporters. We do not share or sell personally identifiable information to any unaffiliated third parties or commercial supporters. Please see our privacy policy at ResearchToPractice.com/Privacy-Policy for more information.

    HOW TO USE THIS CME ACTIVITY
    This CME activity consists of a video component. To receive credit, the participant should watch the video, complete the Post-test with a score of 80% or better and fill out the Educational Assessment and Credit Form located at ResearchToPractice.com/GICancers16/Roundtable/CME.

    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 conflicts of interest with faculty, planners and managers of CME activities. 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 relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Tanios Bekaii-Saab, MD
    Co-Leader, GI Cancer Program
    Mayo Clinic Cancer Center
    Senior Associate Consultant
    Mayo Clinic, Arizona
    Phoenix, Arizona

    Consulting Agreements: Amgen Inc, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, EMD Serono Inc, Genentech BioOncology, Lilly, Merrimack Pharmaceuticals Inc, Pfizer Inc, Taiho Oncology Inc; Data and Safety Monitoring Board: Exelixis Inc.

    Heinz-Josef Lenz, MD
    Professor of Medicine and Preventive Medicine
    J Terrence Lanni Chair for Cancer Research
    Director, GI Oncology Program
    Co-Director, Clinical Research
    Scientific Director, Cancer Genetics Unit
    USC/Norris Comprehensive Cancer Center
    Los Angeles, California

    Advisory Committee and Consulting Agreements: Bayer HealthCare Pharmaceuticals, EMD Serono Inc, Genentech BioOncology, Merck, Roche Laboratories Inc; Contracted Research: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, EMD Serono Inc, Genentech BioOncology, Merck, Roche Laboratories Inc; Other Remunerated Activities: Takeda Oncology.

    EDITOR — Dr 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, Acerta Pharma, Agendia Inc, Amgen Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, ImmunoGen Inc, Incyte Corporation, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics LLC, an AbbVie Company, 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 relevant 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, Merrimack Pharmaceuticals Inc, 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: July 2016
    Expiration date: July 2017


    After completing the Post-test, learners may download and review the answers here in order to identify further areas of study.

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Watch video
(WIFI is recommended for best performance):
Introduction
About this program
Module 1: Metastatic Gastroesophageal Cancer (mGEC)
Second-line treatment of HER2-negative mGEC: Role of ramucirumab
Second-line treatment of HER2-positive mGEC: Continuation of trastuzumab, role of ramucirumab
Module 2: Metastatic Pancreatic Cancer (mPC)
Second-line systemic therapy for mPC
Tolerability of irinotecan liposome injection (MM-398) in the treatment of mPC
Incorporation of irinotecan liposome-based therapy into the treatment algorithm for mPC
Module 3: Metastatic Colorectal Cancer (mCRC) — Up-Front and Second-Line Treatment
Systemic management of BRAF V600E-mutant mCRC
Selection of second-line therapy for pan-RAS wild-type mCRC
HER2 testing in mCRC; management of HER2-positive mCRC
Module 4: Colorectal Cancer — Later-Line Treatment
Tumor cavitation of lung metastases and anti-angiogenic therapy, including regorafenib
“On-target” anti-angiogenic side effects, such as hoarseness
Dosing of regorafenib for patients with mCRC
Dose escalation of regorafenib in clinical practice
Mechanism of action, efficacy and tolerability of TAS-102 as later-line therapy for mCRC
Sequencing regorafenib and TAS-102 for the later-line treatment of mCRC
Advantages of oral therapies in terms of quality of life
Module 5: Colorectal Cancer — Management of Hepatic-Only Metastases
Preoperative and “pseudoadjuvant” systemic therapy for patients with isolated, resectable hepatic metastases
Conversion therapy for patients with borderline-resectable hepatic metastases
SIRFLOX Phase III study of first-line mFOLFOX6 with or without bevacizumab, with or without yttrium-90 microspheres for nonresectable hepatic metastases
Patient selection for treatment with yttrium-90 microspheres for hepatic metastases
Module 6: New Agents in Gastrointestinal (GI) Cancers
DNA mismatch repair deficiency in GI cancers and response to anti-PD-1 immune checkpoint inhibitors
Use of anti-PD-1 immune checkpoint inhibitors for patients with autoimmune disorders
Biologic underpinnings and targeting of cancer stemness
Efficacy, tolerability and ongoing studies with napabucasin (BBI-608) stemness-based therapy in colon, gastric and pancreatic cancer
Module 7: Psychosocial Issues in GI Cancer Management
Personalizing emotional support and guidance for patients with metastatic disease
Personal perspective on caring for patients with metastatic GI cancers
Supporting minor children with parents or grandparents with advanced cancer
Social support and spirituality in coping with metastatic GI cancers