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Patterns of Care in Medical Oncology: Current Practice Patterns of General Medical Oncologists — Metastatic Non-Small Cell Lung Cancer Module
Released October 2014

Patterns of Care in Lung Cancer is a unique CME activity that presents findings from a national survey of general oncologists and perspectives of clinical investigators on their approach to key management challenges with regard to maintenance therapy for patients with lung cancer. Featuring commentary from Drs Suresh S Ramalingam and Heather Wakelee. (Text and Video Content)

CE Disclosures and Faculty Information

    Lung cancer is the leading cause of cancer mortality in the United States for both men and women, and it is estimated that 224,210 new cases will occur in 2014. Despite significant progress in the management of early-stage disease, survival rates for advanced lung cancer remain poor, with less than 5% of patients surviving 5 years. The development of novel targeted agents that show activity and a tolerable side-effect profile has led to increasing interest in using them to maintain response to initial therapy. Maintenance therapy with chemotherapy and molecular-targeted agents has been investigated extensively in non-small cell lung cancer (NSCLC). Considerable controversy regarding the use of this treatment approach persists despite improvements in progression-free survival and often overall survival. Although various maintenance strategies have been incorporated into current treatment algorithms, little is known about the adoption of these therapeutic approaches in clinical practice.

    In January 2014 more than 6,500 practicing oncologists from Research To Practice's proprietary email database were invited to complete an extensive case-based survey focused in part on the systemic management of "pan-wild-type" lung cancer. This CME endeavor documents the self-reported practice patterns of 101 general medical oncologists who elected to participate. The activity also offers clinical investigator perspectives on these findings in addition to their preferred approaches to the same scenarios examined. This information is presented in an effort to allow practicing medical oncologists to compare and contrast their own practice patterns to those of their peers and lung cancer experts and modify them accordingly.


    • Formulate a rational approach for molecular testing of tumors to identify distinct subtypes of lung cancer, including those with EGFR mutations, EML4-ALK gene fusions and other recently identified driver mutations, for use in determining potential treatment options for patients.
    • Evaluate the effects of patient age and performance status on the selection of first-line and maintenance biologic therapy and/or chemotherapy for patients with metastatic non-small cell lung cancer (mNSCLC).
    • Compare maintenance treatment strategies used by general oncologists and cancer clinical investigators, and apply this knowledge to the routine care of 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

    This CME activity contains text, slide and video components. The participant should read the text portion, review the slides and watch the video.

    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 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:

    Suresh S Ramalingam, MD

    Professor of Hematology and Medical Oncology
    Director, Division of Medical Oncology
    Emory University
    Winship Cancer Institute
    Atlanta, Georgia

    Advisory Committee: AstraZeneca Pharmaceuticals LP; Consulting Agreements: ARIAD Pharmaceuticals Inc, AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Celgene Corporation, Genentech BioOncology, Gilead Sciences Inc, Lilly, Novartis Pharmaceuticals Corporation; Contracted Research: Bristol-Myers Squibb Company.

    Heather Wakelee, MD
    Associate Professor of Medicine
    Division of Oncology
    Stanford University School of Medicine
    Stanford Cancer Institute
    Stanford, California

    Contracted Research: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Clovis Oncology, Exelixis Inc, Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc, Xcovery.

    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, Amgen Inc, Astellas, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals Inc, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc, Teva Oncology 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 Genentech BioOncology and Millennium: The Takeda Oncology Company.

    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: October 2014
    Expiration date: October 2015

Acknowledge and close

Click on the links below to review slides, editor's comments and select publications:
Chapter 1: Genomic Testing
Patient selection for EGFR and ALK testing in NSCLC
Adoption of next-generation sequencing for lung cancer
Chapter 2: First-Line and Maintenance Therapy for Adenocarcinoma of the Lung
First-line treatment of metastatic adenocarcinoma of the lung (age 60)
Duration of first-line treatment for metastatic adenocarcinoma
Maintenance treatment for metastatic adenocarcinoma
First-line treatment of metastatic adenocarcinoma after prior adjuvant chemotherapy
Age and use of bevacizumab
First-line treatment for metastatic adenocarcinoma in the elderly (age 80)
Maintenance treatment for metastatic adenocarcinoma in the elderly (age 80)
Chapter 3: First-Line and Maintenance Therapy for Squamous Cell Lung Cancer
First-line treatment for metastatic squamous cell lung cancer (mSCLC, age 60)
Maintenance treatment for mSCLC
First-line treatment for mSCLC in the elderly (age 80)
Use of bevacizumab in patients with mSCLC and no evidence of disease in the lungs
Chapter 4: Additional Treatment Considerations
Use of pemetrexed in patients with impaired renal function
Long-term toxicity of maintenance pemetrexed
Monitoring for proteinuria in patients receiving bevacizumab
Management of hypertension in patients receiving bevacizumab