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Bladder Cancer Update & Renal Cell Cancer Update, 2017 (Video Program)
Released May 2017

Highlights from video interviews with Drs Matthew D Galsky and Elizabeth R Plimack on the treatment of bladder cancer and with Drs Robert J Motzer and Brian I Rini on the management of renal cell cancer.

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists, hematologists, hematology-oncology fellows, radiation oncologists, urologists and other healthcare providers involved in the treat­ment of bladder and renal cell cancers.

    OVERVIEW OF ACTIVITY
    Cancers of the genitourinary (GU) system affect hundreds of thousands of individuals within the United States each year. Among these, tumors of the bladder, kidney and renal pelvis are among the most prevalent and are therefore the topic of extensive ongoing clinical research. As such, the clinical management of these diseases is currently in a state of evolution, necessitating rapid and consistent access to learning opportunities for clinicians who provide care for these patients. Featuring information on the latest research developments along with expert perspectives, this CME program is designed to assist medical oncologists, urologists and radiation oncologists with the formulation of up-to-date clinical management strategies for the care of patients with GU cancers.

    LEARNING OBJECTIVES

    • Develop an evidence-based approach to the sequencing of systemic therapies for patients with advanced renal cell carcinoma (RCC), incorporating cytokines, multikinase inhibitors, anti-VEGF antibodies, mTOR inhibitors and immune checkpoint inhibitors.
    • Appreciate the recent FDA approvals in advanced RCC, and develop strategies to optimally integrate these agents into the management of this disease.
    • Recognize toxicities attributable to diverse molecular-targeted treatments for RCC, and offer preventive or emergent interventions to minimize or ameliorate these side effects.
    • Recall the unique mechanism of action of, available clinical trial data with and clinical indications for the use of atezolizumab in patients with relapsed/refractory advanced urothelial bladder cancer, and use this information to guide nonprotocol treatment planning.
    • Recognize immune-related adverse events and other common side effects associated with approved and developmental immunotherapeutics in order to offer supportive management strategies.
    • Recall available and emerging data with novel anti-PD-1/PD-L1 antibodies currently under investigation for bladder cancer and RCC, and, where applicable, refer eligible patients for trial participation or expanded access programs.

    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 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 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/RenalBladder117/Video/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:

    Matthew D Galsky, MD
    Director, Genitourinary Medical Oncology
    Director, Novel Therapeutics Program
    Tisch Cancer Institute
    Professor of Medicine
    Icahn School of Medicine at Mount Sinai
    New York, New York

    Advisory Committee: Astellas Pharma Global Development Inc, Genentech BioOncology, Novartis; Contracted Research: Bristol-Myers Squibb Company, Celgene Corporation; Ownership Interest: Dual Therapeutics.

    Elizabeth R Plimack, MD, MS
    Director, Genitourinary Clinical Research
    Associate Professor
    Department of Hematology/Oncology
    Fox Chase Cancer Center
    Temple Health
    Philadelphia, Pennsylvania

    Advisory Committee: Acceleron Pharma, Bristol-Myers Squibb Company, Genentech BioOncology, Novartis, Pfizer Inc, Roche Laboratories Inc; Consulting Agreements: Bristol-Myers Squibb Company, Lilly, Pfizer Inc; Contracted Research: Acceleron Pharma, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, GlaxoSmithKline, Lilly, Merck, Pfizer Inc.

    Robert J Motzer, MD
    Medical Oncologist
    Memorial Sloan Kettering Cancer Center
    New York, New York

    Consulting Agreements: Eisai Inc, GlaxoSmithKline, Novartis, Pfizer Inc; Contracted Research: Bristol-Myers Squibb Company, Eisai Inc, Genentech BioOncology, Novartis, Pfizer Inc, Roche Laboratories Inc.

    Brian I Rini, MD
    Department of Solid Tumor Oncology and Urology
    Cleveland Clinic Taussig Cancer Center
    Associate Professor of Medicine
    CCF/CWRU Lerner College of Medicine
    Cleveland, Ohio

    Consulting Agreements: Merck, Pfizer Inc; Contracted Research: Bristol-Myers Squibb Company, Genentech BioOncology, Merck, Pfizer Inc, Roche Laboratories Inc.

    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, 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, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals 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 AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Exelixis Inc, Genentech BioOncology and Novartis.

    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: May 2017
    Expiration date: May 2018

    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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Watch video
(WIFI is recommended for best performance):
BLADDER CANCER

(Neo)adjuvant treatment for urothelial bladder cancer (UBC)

  • Benefits of (neo)adjuvant treatment for UBC
  • Chemotherapeutic regimens commonly used in the neoadjuvant and adjuvant settings

Therapeutic options for patients with advanced UBC

  • Case discussion: A 52-year-old man who initially receives treatment for nonmuscle-invasive UBC presents 4 years later with metastatic disease
  • Selection of first-line therapy for metastatic UBC
  • Activity and tolerability of the recently FDA-approved anti-PD-L1 antibody atezolizumab for advanced UBC
  • VEGF tyrosine kinase (TKI)-based therapy for patients with bladder cancer

Immune checkpoint blockade in UBC

  • Overview of immune checkpoint blockade in metastatic UBC
  • Results of the Phase II IMvigor 210 trial of atezolizumab for patients with platinum-pretreated or cisplatin-ineligible and inoperable locally advanced or metastatic UBC
  • Activity and predictors of response to immune checkpoint inhibitors in previously treated UBC
  • Response of smokers versus never smokers to pembrolizumab on the Phase III KEYNOTE-045 trial
  • Perspective on using immune checkpoint inhibitors as first-line therapy for metastatic UBC
  • Clinical experience with checkpoint inhibitor-associated immune-related adverse events
  • Ongoing trials evaluating immune checkpoint inhibitors in the adjuvant and metastatic settings
RENAL CELL CANCER

Adjuvant sorafenib or sunitinib for renal cell carcinoma (RCC)

  • Results of the Phase III ASSURE and S-TRAC trials investigating adjuvant sorafenib or sunitinib for unfavorable/high-risk RCC
  • Management of dermatologic toxicities associated with sunitinib

Selection and sequencing of therapeutic options for advanced RCC

  • Selection of first- and second-line therapy for metastatic RCC
  • Optimal sequencing of VEGF TKIs for RCC
  • Results of trials evaluating cabozantinib versus everolimus (METEOR) or sunitinib (CABOSUN) for advanced RCC
  • Side-effect profile and dosing of cabozantinib in advanced RCC
  • Integration of lenvatinib/everolimus into the clinical algorithm for patients with RCC
  • Perspective on the efficacy and tolerability of lenvatinib and everolimus as single agents and in combination

Immune checkpoint blockade in RCC

  • Rationale for the use of immune checkpoint blockade for RCC
  • Results of the Phase III CheckMate 025 study: Activity and tolerability of nivolumab versus everolimus for advanced RCC
  • Activity of nivolumab alone and in combination with ipilimumab for metastatic RCC
  • Response to immune checkpoint inhibition, duration of therapy and immune-related adverse events in RCC
  • Ongoing trials evaluating immunotherapies in combination with targeted therapies for metastatic RCC