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New Biological Insights and Recent Therapeutic Advances in the Management of Lung Cancer: A Clinical Investigator Think Tank
Released August 2015

Video excerpts from a clinical investigator Think Tank featuring perspectives from Drs David P Carbone, Mark G Kris, Corey J Langer, Geoffrey R Oxnard, David R Spigel and Anne S Tsao on emerging data and recent therapeutic advances in the treatment of lung cancer. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists, hematology-oncology fellows and other healthcare providers involved in the treatment of lung cancer.

    OVERVIEW OF ACTIVITY
    The development of new therapeutic strategies beyond cytotoxic chemotherapy has been the focus of extensive recent research and has led to an explosion in lung cancer genetic and biologic knowledge. The result has been the availability of several molecular-targeted therapies demonstrating some degree of activity in subsets of patients with non-small cell lung cancer (NSCLC) and exhibiting tolerability profiles that are distinct from those of traditional chemotherapeutic agents. These novel agents inhibit specific cell growth pathways and prolong survival for patients with NSCLC in large, randomized clinical trials. Other agents developed to block multiple cellular pathways or multiple components of a single biologic pathway are still under active investigation. While the advent of these next-generation targeted treatments presents new promise of both efficacy and enhanced safety in the management of lung cancer, it also challenges practicing oncologists to appropriately select individuals who may benefit from these agents. In addition, clinical oncologists need to determine how to integrate such therapies into standard lung cancer treatment algorithms as they become available.

    Although several consensus- and evidence-based treatment guidelines are available to assist clinicians in making lung cancer treatment decisions, many areas of controversy persist within academic and community settings. This CME program brings together leading clinical investigators and general oncologists to provide biological insights into the recent therapeutic advances in the management of lung cancer. By reviewing the available clinical trial data and relevant case scenarios, this initiative will provide insight into the gaps in medical knowledge and illuminate treatment ambiguities pertinent to lung cancer.

    LEARNING OBJECTIVES

    • Develop an evidence-based strategy for the treatment of localized NSCLC, exploring the role of adjuvant systemic therapy.
    • Devise an evidence-based approach to the selection of induction and maintenance biologic therapy and/or chemotherapy for patients with advanced pan-wild-type NSCLC.
    • Employ an understanding of personalized medicine to individualize the use of available EGFR inhibitors in the treatment of NSCLC before and after disease progression on an EGFR tyrosine kinase inhibitor (TKI).
    • Communicate the efficacy and safety of crizotinib and other emerging ALK inhibitors to appropriate patients with NSCLC, considering the predictive utility of ALK and ROS1 mutation testing.
    • Evaluate the emerging data from clinical trials of the third-generation EGFR TKIs, rociletinib and AZD9291, in EGFR mutation-positive NSCLC.
    • Describe emerging data on the efficacy and safety of tumor immunotherapy directed at the PD-1/PD-L1 pathway in lung cancer, and consider this information when counseling patients regarding clinical trial participation.
    • Recognize the results of recently completed Phase III trials examining the efficacy and safety of the novel monoclonal antibodies necitumumab and ramucirumab for patients with advanced NSCLC.
    ACCREDITATION STATEMENT
    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

    CREDIT DESIGNATION STATEMENT

    CME credit is no longer available for this issue

    HOW TO USE THIS CME ACTIVITY
    This CME activity contains both audio and print components. The participant should review the CME information, listen to the audio MP3s and read the text portion. The text portion of this activity contains edited comments, clinical trial schemas, graphics and references that supplement the audio MP3s, as well as links to relevant full-text articles, abstracts, trial information and other web resources.

    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:

    David P Carbone, MD, PhD
    Barbara J Bonner Chair in Lung Cancer Research
    President-Elect, International Association for the Study of Lung Cancer
    Professor of Medicine
    Director, James Thoracic Oncology Center
    James Cancer Center
    The Ohio State University Medical Center
    Columbus, Ohio

    Consulting Agreements: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Eisai Inc, Genentech BioOncology, GlaxoSmithKline, Merck, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc.

    Mark G Kris, MD
    William and Joy Ruane Chair in Thoracic Oncology
    Attending Physician, Thoracic Oncology Service
    Memorial Sloan Kettering Cancer Center
    New York, New York

    Advisory Committee: Daiichi Sankyo Inc; Consulting Agreements: Array BioPharma Inc, AstraZeneca Pharmaceuticals LP, Clovis Oncology; Contracted Research: Pfizer Inc, Puma Biotechnology Inc; Other Remunerated Activities: Roche Laboratories Inc.

    Corey J Langer, MD
    Director of Thoracic Oncology
    Abramson Cancer Center
    Professor of Medicine
    Perelman School of Medicine
    University of Pennsylvania
    Vice Chair, Radiation Therapy Oncology Group
    Philadelphia, Pennsylvania

    Advisory Committee: Abbott Laboratories, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clarient Inc, Clovis Oncology, Genentech BioOncology, Lilly, Merck, Myriad Genetic Laboratories Inc, Roche Laboratories Inc; Consulting Agreements: Abbott Laboratories, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Genentech BioOncology, Lilly, Merck, Roche Laboratories Inc, Takeda Oncology; Contracted Research: Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Genentech BioOncology, GlaxoSmithKline, Lilly, Merck, Pfizer Inc, Takeda Oncology, Veridex LLC; Data Safety Monitoring Committee: Amgen Inc, Synta Pharmaceuticals Corp.

    Geoffrey R Oxnard, MD
    Assistant Professor of Medicine
    Dana-Farber Cancer Institute
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee: Boehringer Ingelheim Pharmaceuticals Inc, Clovis Oncology, Genentech BioOncology, Sanofi; Consulting Agreement: AstraZeneca Pharmaceuticals LP; Contracted Research: Pfizer Inc.

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

    No financial interests or affiliations to disclose.

    Anne S Tsao, MD
    Associate Professor
    Director, Mesothelioma Program
    Director, Thoracic Chemo-Radiation Program
    The University of Texas MD Anderson Cancer Center
    Department of Thoracic/Head and Neck Medical Oncology
    Houston, Texas

    Advisory Committee: Astellas Scientific and Medical Affairs Inc, Boehringer Ingelheim Pharmaceuticals Inc, Genentech BioOncology, Lilly, MedImmune Inc, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc, Takeda Oncology; Contracted Research: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, GlaxoSmithKline, MedImmune Inc, Merck.

    MODERATOR — 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 Scientific and Medical Affairs Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics 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, ImmunoGen Inc, Incyte Corporation, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Myriad Genetic Laboratories Inc, NanoString Technologies, 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 Astellas Scientific and Medical Affairs Inc, AstraZeneca Pharmaceuticals LP, Biodesix Inc, Clovis Oncology, Foundation Medicine, Genentech BioOncology, Lilly, Merck and Novartis Pharmaceuticals Corporation.

    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: August 2015
    Expiration date: August 2016

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Watch video
(WIFI is recommended for best performance):

ALK-Rearranged, Advanced NSCLC
A 35-year-old woman in respiratory failure due to lung cancer who needs rapid initiation of treatment
Targeted agents versus whole brain radiation therapy for patients with asymptomatic EGFR- or ALK-mutant CNS metastases
Follow-up of the 35-year-old woman who was determined to have ALK-rearranged non-small cell lung cancer (NSCLC) and received crizotinib
Potent activity of the ALK inhibitor ceritinib accompanied by significant gastrointestinal toxicity
A woman with ALK-rearranged, advanced NSCLC who received full-dose ceritinib for 2 years
Safety and activity of alectinib in crizotinib-resistant, ALK-rearranged, advanced NSCLC
Potency and tolerability of emerging ALK inhibitors compared to crizotinib
Efficacy of pemetrexed in ALK-rearranged NSCLC
EGFR Mutation-Positive, Advanced NSCLC
Erlotinib and bevacizumab as first-line therapy in patients with advanced nonsquamous NSCLC harboring EGFR mutation
IMPRESS: Gefitinib/chemotherapy versus chemotherapy in EGFR-mutant NSCLC after progression on first-line gefitinib
Role of afatinib for patients with disease progression on erlotinib
Rociletinib in EGFR-mutant, advanced NSCLC with the T790M resistance mutation
A 62-year-old man with EGFR-mutant, advanced NSCLC treated on study with AZD9291 after disease progression on erlotinib
Activity and tolerability of AZD9291 in EGFR inhibitor-resistant, advanced NSCLC with the T790M mutation
Next-Generation Sequencing; Other Actionable Mutations
Increasing role of next-generation sequencing (NGS) in clinical practice
A patient whose tumor was ALK wild type by FISH testing but subsequently identified by NGS as ALK rearranged
An 80-year-old woman with advanced, HER2-mutant nonsquamous NSCLC receives neratinib/temsirolimus on a clinical trial
A patient with BRAF-mutant, advanced NSCLC who had a durable response to vemurafenib
A patient with a RET-rearranged tumor identified through multiplex testing receives cabozantinib
Immunotherapy in NSCLC
A man with pan-wild-type metastatic adenocarcinoma of the lung receives nivolumab for 2 years as second-line therapy
A 76-year-old man with heavily treated metastatic squamous-cell NSCLC has a response to pembrolizumab longer than 15 months
Checkpoint inhibitor-associated toxicities
PD-L1 expression and response to anti-PD-1/anti-PD-L1 antibodies
Pseudoprogression with anti-PD-1/PD-L1 antibodies
Pan-Wild-Type, Advanced NSCLC
An 81-year-old woman with pan-wild-type metastatic adenocarcinoma of the lung receives carboplatin/pemetrexed
Organ function and performance status to identify elderly patients who can tolerate chemotherapy
Factors affecting the decision to administer 4 versus 6 cycles of a platinum-based doublet for metastatic NSCLC
Algorithm for maintenance treatment after a first-line platinum-based doublet
Benefits of second-line ramucirumab/docetaxel observed in the REVEL study
Perspective on the SQUIRE study of necitumumab combined with cisplatin/gemcitabine in advanced squamous cell NSCLC
An 82-year-old man with advanced NSCLC has a VeriStrat® assay performed and experiences durable benefit from erlotinib
Predictive value of the VeriStrat assay for patients with NSCLC treated with second-line erlotinib or chemotherapy
Adjuvant Therapy for Localized NSCLC
A 61-year-old man after lobectomy for T2AN0M0, EGFR-mutant adenocarcinoma of the lung
Clinical implications of the RADIANT study of adjuvant erlotinib with or without chemotherapy
RADIANT subset analysis: Benefits of adjuvant erlotinib in patients with EGFR-mutant NSCLC
SELECT: A multicenter Phase II trial of adjuvant erlotinib for resected early-stage, EGFR-mutant NSCLC
Nonresearch use of EGFR tyrosine kinase inhibitors as adjuvant therapy for patients with sensitizing EGFR mutations