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Meet The Professors: Acute Myeloid Leukemia Edition, 2017 (Video Program)
Released March 2017

A case-based roundtable discussion on the management of acute myeloid leukemia. Featuring faculty members Drs Jorge E Cortes and Richard M Stone and community oncologists Drs Suzanne Cole, Lyle Feinstein and Jewel Johl. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists and other healthcare providers involved in the treatment of acute myeloid leukemia (AML).

    OVERVIEW OF ACTIVITY
    AML is the most common form of leukemia among adults, and in 2016 an estimated 19,950 cases will be diagnosed and 10,430 individuals will die from this disease. Despite the frequency of AML and its associated morbidity and mortality, standard treatment algorithms for this disease have largely remained unchanged. Historically, front-line management has included induction chemotherapy with cytarabine and an anthracycline in an effort to reduce leukemic burden and induce disease remission followed by consolidation strategies using various doses and sequences of similar agents with or without stem cell transplantation depending on the patient’s ability to tolerate intensive therapy.

    Much dismay has been expressed over the lack of progress in the management of this challenging disease, but in truth a number of recent scientific and therapeutic advances indicate that the future may be much brighter for patients with AML. Significantly, recent progress in molecular diagnostics has not only led to improvements in risk stratification but has also raised the potential hope that effective targeted therapeutic interventions may soon become available. Specifically, molecular diagnostics have led to the identification of several novel genetic markers, including FLT3-ITD, NPM1, CEBPA, c-KIT and others, the presence or absence of which appear to inform patient outcomes. As a result, a number of these have been incorporated into available risk stratification models and clinical practice Guidelines, including those developed by the National Comprehensive Cancer Network.

    An array of other targeted and novel therapeutics are being investigated across a variety of AML subsets and clinical situations. These, in addition to the significant strides that have been made to date, provide reason for hope that new treatments will be approved in the near future and that their incorporation into standard care will improve outcomes for patients with this disease. To offer optimal patient care, clinicians need educational interventions designed to increase their knowledge of recent advancements and appropriately counsel them regarding how those new strategies can be safely and effectively integrated into current protocol and off-protocol treatment algorithms for patients with AML.

    LEARNING OBJECTIVES

    • Consider age, performance status and disease-related factors to guide the selection of appropriate patients for treatment with induction therapy and/or allogeneic stem cell transplantation.
    • Appreciate the clinical and prognostic significance of specific cytogenetic and molecular abnormalities, and employ this information in treatment decision-making for patients with AML.
    • Recognize the importance of genetic testing in the treatment of AML.
    • Assess available research evidence with existing and emerging FLT3 inhibitors, and use these data to inform decisions concerning clinical care and protocol opportunities.
    • Appreciate the recent FDA breakthrough designations for and available data with midostaurin and venetoclax in preparation for their potential availability in the clinic.

    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 2.75 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 2.75 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/MTPAML116/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:

    Jorge E Cortes, MD
    Jane and John Justin Distinguished Chair in Leukemia Research
    Chief, CML and AML Sections
    Deputy Chair, Department of Leukemia
    The University of Texas MD Anderson Cancer Center
    Houston, Texas

    Consulting Agreements: Bristol-Myers Squibb Company, Daiichi Sankyo Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc; Contracted Research: Astellas Pharma Global Development Inc, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc.

    Richard M Stone, MD
    Director, Adult Leukemia Program
    Dana-Farber Cancer Institute
    Professor of Medicine
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee: Agios Pharmaceuticals, Amgen Inc, Arog Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celator Pharmaceuticals Inc, Celgene Corporation, Genentech BioOncology, Janssen Biotech Inc, Merck, Novartis Pharmaceuticals Corporation, Pfizer Inc; Clinical Research: Novartis Pharmaceuticals Corporation; Data and Safety Monitoring Board: Celgene Corporation.

    COMMUNITY ONCOLOGISTS — The following community oncologists (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Suzanne Cole, MD
    Hematologist and Medical Oncologist
    Mercy Hospital Coletta Cancer Center
    Oklahoma City, Oklahoma

    No relevant conflicts of interest to disclose.

    Lyle Feinstein, MD
    Miami Cancer Institute
    Miami, Florida

    No relevant conflicts of interest to disclose.

    Jewel Johl, MD
    Diablo Valley Oncology
    Pleasant Hill, California

    Speakers Bureau: Takeda Oncology.

    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, Acerta Pharma, Agendia Inc, Amgen Inc, Ariad Pharmaceuticals 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, Infinity Pharmaceuticals Inc, 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, Tesaro Inc, 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 AbbVie Inc, Astellas Pharma Global Development Inc, Celgene Corporation 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: January 2017
    Expiration date: January 2018

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

Acknowledge and close

Watch video
(WIFI is recommended for best performance):
Module 1: Targeted therapy
Topics:
  • Potential synergy between targeted therapy and chemotherapy
  • Importance of a combination therapy approach
  • Incidence of FLT3 mutations and effect on prognosis
  • FLT3 inhibitors in development
  • Phase III RATIFY trial of midostaurin with chemotherapy for untreated, FLT3 mutation-positive AML
  • Potential incorporation of midostaurin into the treatment algorithm
  • Sorafenib
  • Quizartinib
  • Gilteritinib
  • Ongoing Phase III trials of single-agent gilteritinib or quizartinib
  • Venetoclax
  • IDH inhibitors
  • Importance of a tailored approach to therapy
Module 2: Other clinical issues in AML management
Topics:
  • Choice of hypomethylating agent for elderly patients
  • Efficacy of 5- versus 7-day azacitidine therapy
  • Assessment of minimal residual disease
  • Dose-intense therapy for chemosensitive AML
  • Transplant outcomes for elderly patients with favorable-risk cytogenetics
  • Use of growth factors as supportive care
  • Use of ports versus PICC lines in patients who are in remission
  • Transplantation for older, healthy patients with unfavorable cytogenetics
  • Approaches to leukapheresis and the use of hydroxyurea
  • Approach to patients with a low LVEF or history of heart failure
  • Considerations for platelet transfusion
  • Ara-C and its possible effects on subsequent transplant
  • “7 + 3” regimen as induction therapy
  • Initial management of mixed-phenotype acute leukemia
Module 3: Case discussions
Topics:
  • 83-year-old man who presents with mild cytopenias receives induction therapy with idarubicin and cytarabine for AML with monosomy 7 (Dr Cole)
  • 71-year-old man with NPM1 mutation-positive AML receives idarubicin/cytarabine induction therapy and is being considered for an allogeneic stem cell transplant (Dr Feinstein)
  • 33-year-old woman with AML and FLT3-ITD and NPM1 mutations experiences a quick relapse after 7 + 3 induction therapy and 1 course of sorafenib (Dr Johl)
  • 44-year-old woman with a KIT mutation receives induction therapy with 7 + 3 and cytarabine/idarubicin (Dr Cole)
  • 54-year-old woman with acute myelomonocytic leukemia achieves a complete response after induction therapy with idarubicin/cytarabine but experiences relapse 1 month later (Dr Feinstein)
  • 63-year-old man with APL and a history of aortic valve replacement receives all-trans retinoic acid (ATRA) induction therapy and experiences differentiation syndrome (Dr Stone)
  • 58-year-old man achieves cytogenetic and molecular remission with ATRA and arsenic as induction therapy but develops edema and pleural effusion (Dr Johl)