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Consensus or Controversy: Clinical Investigators Provide Perspectives on Targeted Treatment of Non-Small Cell Lung Cancer
Released September 2016

Proceedings from a CME symposium held during the 2016 IASLC Chicago Multidisciplinary Symposium in Thoracic Oncology. Featuring perspectives from Drs Joel W Neal, Geoffrey R Oxnard, Gregory J Riely and David R Spigel. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for hematologists, medical oncologists and other healthcare providers involved in the treatment of non-small cell lung cancer (NSCLC).

    Lung cancer is a devastating disease with broad-reaching impact on public health, as it accounts for 14% of all new cancer cases in the United States and the most cancer-related deaths among both men and women. Despite the many advances over the past few decades related to surgery, radiation therapy and chemotherapy, death rates attributable to lung cancer have remained relatively unchanged. Today, however, scientists and clinicians working in this area of cancer medicine have renewed optimism that these trends have started to change as recent research advances have led to an explosion in lung cancer genetic and biologic knowledge. A major focus of recent lung cancer research has been the development — and subsequent approval — of a number of molecular-targeted agents and the identification of related biomarkers to help guide treatment selection for those individuals who harbor specific oncogenic alterations.

    These video proceedings from a CME symposium held during the 2016 IASLC Chicago Multidisciplnary Symposium in Thoracic Oncology feature discussions with leading researchers with an expertise in the management of lung cancer about clinical research findings relevant to treatment for patients with targetable tumor mutations to address existing uncertainties and help keep clinicians up to date and informed on the targeted treatment of NSCLC.


    • Discriminate among molecular determinants that may be used to refine NSCLC prognosis and/or predict therapeutic response to an individual treatment, and apply available clinical guidelines to appropriately select patients for biomarker assessment.
    • Recognize available and emerging research information validating the utility of blood-based diagnostic assays to identify or measure lung cancer biomarkers, and assess how, if at all, these testing platforms can be used by practicing oncologists outside of a research setting.
    • Employ an understanding of personalized medicine to individualize the use of available EGFR inhibitors in the long-term care of patients with EGFR mutation-positive NSCLC.
    • Describe mechanisms of tumor resistance to EGFR tyrosine kinase inhibitors (TKIs) and the clinical significance of T790M mutations, and discern how osimertinib can be optimally used for patients with progressive EGFR mutation-positive disease.
    • Develop an understanding of the mechanisms of action, available research data and ongoing trials of investigational EGFR TKIs under development for the management of progressive EGFR-positive advanced NSCLC.
    • Communicate the efficacy and safety of crizotinib, ceritinib, alectinib and other emerging ALK inhibitors to appropriate patients with NSCLC, considering the predictive utility of ALK mutation testing.
    • Assess new oncogenic pathways mediating the growth of unique NSCLC tumor subsets, and recall emerging data with experimental agents exploiting these targets.
    • Recognize the advantages and limitations of multiplex and next-generation sequencing platforms, and determine their clinical and/or research application for patients with NSCLC.

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

    CME credit is no longer available for this issue


    CME credit is no longer available for this issue


    CME credit is no longer available for this issue

    This CME activity consists of a video component.

    CME credit is no longer available for this issue

    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:

    Joel W Neal, MD, PhD
    Assistant Professor of Medicine
    Division of Oncology
    Stanford Cancer Institute
    Stanford University
    Palo Alto, California

    Consulting Agreements: ARIAD Pharmaceuticals Inc, ARMO BioSci­ences, Boehringer Ingelheim Pharmaceuticals Inc, CARET/Physi­cians Resource Management, Clovis Oncology, Nektar; Contracted Research: ARIAD Pharmaceuticals Inc, ArQule Inc, Boehringer Ingelheim Pharmaceuticals Inc, Exelixis Inc, Genentech BioOncology, Merck, Nektar, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc.

    Geoffrey R Oxnard, MD
    Lowe Center for Thoracic Oncology
    Dana-Farber Cancer Institute
    Assistant Professor of Medicine
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee: ARIAD Pharma­ceuticals Inc, AstraZeneca Pharmaceuticals LP, Boehringer Ingel­heim Pharmaceuticals Inc, Genentech BioOncology, Inivata, Takeda Oncology; Consulting Agreements: AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc.

    Gregory J Riely, MD, PhD
    Associate Attending
    Memorial Sloan Kettering Cancer Center
    New York, New York

    Consulting Agreement: Genentech BioOncology; Contracted Research: ARIAD Pharmaceuticals Inc, Astellas Pharma Global Development Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc.

    David R Spigel, MD
    Program Director, Lung Cancer Research
    Sarah Cannon Research Institute
    Nashville, Tennessee

    Advisory Committee: Bristol-Myers Squibb Company, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc; Data and Safety Monitoring Board: Merck.

    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 Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Foundation Medicine and Genentech BioOncology.

    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: September 2016
    Expiration date: September 2017

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Watch video
(WIFI is recommended for best performance):
Clinical Algorithms for Biomarker Testing
Module 1 — Key Clinical Questions:
  • Type of mutation testing prior to first-line treatment?
  • Multiplex/next-generation sequencing (NGS) for patients who have exhausted all treatment options?
  • Patients with negative EGFR/ALK standard assays with positive multiplex/NGS and response to treatment?
Management of Patients with EGFR Tumor Mutations
Module 2 — Key Clinical Questions:
  • First-line treatment recommendation for a patient with metastatic NSCLC and EGFR mutation?
  • Evaluate for T790M mutation after progression on EGFR TKI? Plasma or tissue biopsy? Urine assay?
  • Therapy recommendation for patient with T790M mutation after progression on erlotinib?
  • Therapy recommendation for patient who is T790M mutation-negative after progression on erlotinib?
  • Sequence immune checkpoint inhibitors in patients with tumor mutations?
Management of Patients with ALK and ROS1 Alterations
Module 3 — Key Clinical Questions:
  • First-line therapy recommendation for patient with metastatic NSCLC and ALK rearrangement?
  • Second-line therapy for patient with ALK-rearranged lung cancer after progression on crizotinib?
  • Second-line therapy for patient with ROS1 rearrangement after progression on crizotinib?
Identification of Other Potentially Targetable Tumor Mutations
Module 4 — Key Clinical Questions:
  • Targeted therapy for patients with NSCLC and MET exon 14 skipping mutations?
  • Targeted therapy for patients with metastatic NSCLC and BRAF V600E mutations?
  • Targeted therapy for patients with metastatic NSCLC and RET rearrangement?
  • Targeted therapy for patients with metastatic NSCLC and HER2 mutation/amplification?