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Beyond the Guidelines: Clinical Investigator Perspectives on the Management of Colorectal, Gastroesophageal and Pancreatic Cancer
Released March 2020

Proceedings from a CME symposium held at the 2020 Gastrointestinal Cancers Symposium. Featuring perspectives from Drs Crystal Denlinger, Howard S Hochster, John L Marshall, Michael J Overman, Philip A Philip and Prof Eric Van Cutsem. (Video Program)

CE Disclosures and Faculty Information

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

    Given the prevalent nature of the disease, extensive resources are allocated to colorectal cancer research and education. Interestingly, however, although individually less frequently encountered, the collection of other noncolorectal GI cancers accounts for more per annum cancer-related deaths than those attributed to tumors of the colon and rectum combined. Among this collection of distinct tumor types, a few areas in particular — namely gastroesophageal and pancreatic cancer — have witnessed several recent advances that have altered or have the potential to drastically alter current treatment considerations and approaches.

    Several consensus- and evidence-based treatment guidelines are available and aim to assist clinicians with making management decisions in this dynamic clinical and research environment. However, in situations where multiple acceptable therapeutic options exist, such guidelines may not be particularly helpful at the time of decision-making. By exploring the perspectives of leading investigators regarding a number of clinical scenarios and reviewing key data sets, these proceedings from a CME symposium during the 2020 Gastrointestinal Cancers Symposium will assist medical oncologists, hematology-oncology fellows, surgeons and other healthcare providers in the development of evidence-based strategies for the treatment of colorectal, gastroesophageal and pancreatic cancer.


    • Develop a long-term care plan for individuals diagnosed with metastatic colorectal cancer, considering biomarker profile (eg, BRAF, MSI status), tumor location, prior systemic therapy, symptomatology, performance status and personal goals of treatment.
    • Use the results of biomarker assessments (eg, HER2, PD-L1 status), clinical factors and patient preferences to optimize the selection and sequence of systemic therapy for locally advanced or metastatic gastric, gastroesophageal and esophageal cancer.
    • Consider age, performance status and other clinical and logistical factors in the selection of systemic therapy for patients with localized, locally advanced or metastatic pancreatic adenocarcinoma.
    • Recall the biologic rationale for, published research data with and ongoing research evaluating the use of immune checkpoint inhibitors alone or in combination with chemotherapy, targeted agents or other immunotherapies in the management of colorectal, gastroesophageal and pancreatic cancer, and identify patients who may be eligible for this strategy in or outside of a clinical trial setting.
    • Design and implement a plan of care to recognize and manage side effects and toxicities associated with novel and recently approved systemic therapies for patients with locally advanced or metastatic colorectal, gastroesophageal and pancreatic cancer to support quality of life and continuation of therapy.
    • Appraise available and emerging data with other investigational agents currently in clinical testing for colorectal, gastroesophageal and pancreatic cancer, and where applicable, refer eligible patients for clinical trial participation.

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

    Research To Practice designates this enduring material for a maximum of 2.75 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.75 Medical Knowledge 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.

    This CME activity consists of a video component. To receive credit, the participant should review the CME information, 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/GICancers20/PanTumor/CME.

    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:

    Crystal Denlinger, MD
    Chief, GI Medical Oncology
    Director, Survivorship Program
    Deputy Director, Phase 1 Program
    Associate Professor, Department of Hematology/Oncology
    Fox Chase Cancer Center
    Philadelphia, Pennsylvania

    Advisory Committee: Astellas, Exelixis Inc; Consulting Agreements: Bristol-Myers Squibb Company, Merck; Contracted Research: Agios Pharmaceuticals Inc, Amgen Inc, Array BioPharma Inc, AstraZeneca Pharmaceuticals LP, BeiGene, Bristol-Myers Squibb Company, Exelixis Inc, Lilly, MacroGenics Inc, Sanofi Genzyme, Zymeworks.

    Howard S Hochster, MD
    Distinguished Professor of Medicine
    Rutgers Robert Wood Johnson Medical School
    Rutgers-CINJ Associate Director, Clinical Research
    Director, Clinical Oncology Research, RWJBarnabas Health
    New Brunswick, New Jersey

    Consulting Agreements: Amgen Inc, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Chengdu Kanghong Pharmaceuticals Group Co Ltd, Exelixis Inc, Roche Laboratories Inc.

    John L Marshall, MD
    Chief, Hematology and Oncology
    Director, Ruesch Center for the Cure of GI Cancers
    Lombardi Comprehensive Cancer Center
    Georgetown University
    Washington, DC

    Advisory Committee, Consulting Agreements and Contracted Research: Amgen Inc, Bayer HealthCare Pharmaceuticals, Caris Life Sciences, Celgene Corporation, Indivumed GmbH, Roche Laboratories Inc, Taiho Oncology Inc; Speakers Bureau: Amgen Inc, Bayer HealthCare Pharmaceuticals, Celgene Corporation, Merck, Roche Laboratories Inc, Taiho Oncology Inc.

    Michael J Overman, MD
    Department of Gastrointestinal Medical Oncology
    Division of Cancer Medicine
    The University of Texas MD Anderson Cancer Center
    Houston, Texas

    Consulting Agreements: Array BioPharma Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, CatalYm, Gritstone Oncology, Promega Corporation, Roche Laboratories Inc; Contracted Research: Apexigen, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Merck, Nouscom, Roche Laboratories Inc.

    Philip A Philip, MD, PhD, FRCP
    Kathryn Cramer Endowed Chair in Cancer Research
    Professor of Oncology and Pharmacology
    Leader, GI and Neuroendocrine Oncology
    Karmanos Cancer Institute
    Wayne State University
    Detroit, Michigan

    Advisory Committee: ASLAN Pharmaceuticals, BioLineRx, Caris Life Sciences, Celgene Corporation, Eisai Inc, Erytech Pharma, Halozyme Inc, Ipsen Biopharmaceuticals Inc, Merck, TriSalus Life Sciences; Consulting Agreements: AbbVie Inc, Merck, Rafael Pharmaceuticals Inc, TriSalus Life Sciences; Contracted Research: Astellas, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, BeiGene, BioLineRx, Boston Biomedical Inc, Bristol-Myers Squibb Company, Caris Life Sciences, Celgene Corporation, Halozyme Inc, Incyte Corporation, Lilly, Novartis, Novocure, QED Therapeutics, Rafael Pharmaceuticals Inc, Roche Laboratories Inc, Taiho Oncology Inc; Data and Safety Monitoring Board/Committee: ASLAN Pharmaceuticals, Blueprint Medicines, Erytech Pharma, Lexicon Pharmaceuticals Inc; Speakers Bureau: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Celgene Corporation, Ipsen Biopharmaceuticals Inc, Merck.

    Eric Van Cutsem, MD, PhD
    Professor of Medicine
    Digestive Oncology
    University Hospital Leuven
    Leuven, Belgium

    Advisory Committee: Array BioPharma Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Biocartis, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, GlaxoSmithKline, Halozyme Inc, Incyte Corporation, Ipsen Biopharmaceuticals Inc, Lilly, Merck KGaA, Merck Sharp & Dohme Corp, Novartis, Pierre Fabre, Roche Laboratories Inc, Servier, Sirtex Medical Ltd, Taiho Oncology Inc; Contracted Research: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Celgene Corporation, Ipsen Biopharmaceuticals Inc, Lilly, Merck KGaA, Merck Sharp & Dohme Corp, Novartis, Roche Laboratories Inc, Servier.

    MODERATOR — Dr Love is president and CEO of Research To Practice. Research To Practice receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Acerta Pharma — A member of the AstraZeneca Group, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Blueprint Medicines, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, EMD Serono Inc, Exelixis Inc, Foundation Medicine, Genentech, Genmab, Genomic Health Inc, Gilead Sciences Inc, Guardant Health, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Loxo Oncology Inc, a wholly owned subsidiary of Eli Lilly & Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, Natera Inc, Novartis, Oncopeptides, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sandoz Inc, a Novartis Division, Sanofi Genzyme, Seattle Genetics, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro, A GSK Company, Teva Oncology, Tokai Pharmaceuticals Inc and Tolero Pharmaceuticals.

    RESEARCH TO PRACTICE CME PLANNING COMMITTEE MEMBERS, STAFF AND REVIEWERS — Planners, scientific staff and independent 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 Array BioPharma Inc, Bayer HealthCare Pharmaceuticals, Boston Biomedical Inc and Tolero Pharmaceuticals, Celgene Corporation, Ipsen Biopharmaceuticals Inc, Merck, Seattle Genetics, and Taiho Oncology Inc.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
    Adobe Flash Player 27 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Release date: March 2020
    Expiration date: March 2021

    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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