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Consensus or Controversy? The Integration of Novel Therapies into the Interdisciplinary Management of Non-Small Cell Lung Cancer with CNS Metastases
Released February 2020

Proceedings from a CME symposium held during the 24th Annual Meeting and Education Day of the Society for Neuro-Oncology. Featuring perspectives from moderator Dr Matthew Gubens and faculty members Drs Manmeet S Ahluwalia, Daniel Gomez and Gregory J Riely. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for neuro-oncologists, neurosurgeons, medical oncologists and other neuro-oncology practitioners involved in the treatment of lung cancer and central nervous system (CNS) metastases.

    CNS metastases are associated with poor prognosis and significant morbidity and present a major therapeutic challenge in the management of non-small cell lung cancer (NSCLC). Historically, local therapies, including whole-brain radiation therapy, stereotactic radiosurgery or a combination of neurosurgery and radiation therapy, have been considered standard. More recently, however, the management of CNS metastases has been reshaped in certain molecularly defined subpopulations of patients with NSCLC (eg, those with EGFR or ALK tumor mutations) for whom the use of systemic targeted therapies has shown superior intracranial outcomes.

    To ensure state-of-the-art and individualized care for patients with NSCLC and CNS metastases, it is essential that clinicians in practice maintain up-to-date knowledge of the safety and efficacy profiles of various therapies in order to establish how they should be optimally integrated into the interdisciplinary management paradigm. These video proceedings from a CME symposium held during the Society for Neuro-Oncology Annual Meeting feature presentations and perspectives from leading investigators as well as discussion of a case-based survey designed to document their usual approaches to a variety of relevant clinical scenarios. By providing information on the latest research developments and their potential application to routine practice, this activity is designed to assist neuro-oncologists, neurosurgeons, medical oncologists and other neuro-oncology practitioners with the formulation of up-to-date clinical management strategies.


    • Discern the overall incidence of CNS involvement among patients with NSCLC, and discuss how the presence of brain or leptomeningeal metastases affects overall prognosis.
    • Differentiate among local therapy techniques for the management of brain metastases stemming from NSCLC, and determine which of these is most appropriate based on patient- and disease-specific factors (performance status, presence of an activating tumor mutation, number and location of lesions, et cetera).
    • Appraise the relative levels of CNS permeability with various EGFR tyrosine kinase inhibitors (TKIs), and discuss how this affects the efficacy of these agents against NSCLC with an EGFR mutation and brain metastases.
    • Review published research data documenting the safety and efficacy of the third-generation EGFR TKI osimertinib in the treatment of brain and leptomeningeal metastases, and discern how this information should be applied to current patient care.
    • Consider the uniqueness of leptomeningeal metastases as a clinical entity, and recall emerging data with promising diagnostic and therapeutic techniques in this setting.
    • Evaluate the activity of FDA-endorsed ALK inhibitors in patients with ALK-rearranged NSCLC and CNS metastases to optimize the selection and sequencing of targeted treatments.
    • Appreciate available clinical trial data with and recall the rationale for ongoing clinical trials evaluating anti-PD-1/PD-L1 antibodies for patients with NSCLC and brain metastases, and apply this information to provide appropriate counseling about protocol and nonresearch treatment options.

    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 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: 


    Matthew Gubens, MD, MS
    Associate Professor, Thoracic Medical Oncology
    University of California, San Francisco
    San Francisco, California

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Genentech, Heron Therapeutics Inc, Roche Laboratories Inc, Takeda Oncology; Contracted Research: Celgene Corporation, Merck, Novartis, OncoMed Pharmaceuticals Inc, Roche Laboratories Inc.


    Manmeet S Ahluwalia, MD
    Professor, Miller Family Endowed Chair in Neuro-Oncology
    Associate Director and Head of Operations
    Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
    Cleveland Clinic
    Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
    Cleveland, Ohio

    Consulting Agreements: AbbVie Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Flatiron Health, FORMA Therapeutics Inc, Karyopharm Therapeutics, Tocagen, Varian Medical Systems Inc, VBI Vaccines Inc; Contracted Research: AbbVie Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Incyte Corporation, Merck, Novocure, Pharmacyclics LLC, an AbbVie Company; Data and Safety Monitoring Board: University of Pennsylvania; Ownership Interest: Doctible, MimiVax; Other Remuneration from Noncommercial Entities: Elsevier, Wiley.

    Daniel Gomez, MD, MBA
    Radiation Oncologist
    Director of Thoracic Radiation Oncology
    Chief of Radiation Oncology, Manhattan Service
    Memorial Sloan Kettering Cancer Center
    New York, New York

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Merck; Contracted Research: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Merck, Varian Medical Systems Inc; Honoraria: Bristol-Myers Squibb Company, Merck, US Oncology, Varian Medical Systems Inc.

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

    Contracted Research: Merck, Mirati Therapeutics, Novartis, Pfizer Inc, Roche Laboratories Inc, Takeda Oncology.

    RESEARCH TO PRACTICE PRESIDENT NEIL LOVE, MD — Dr Love is president and CEO of Research To Practice. Research To Practice receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Acerta Pharma — A member of the AstraZeneca Group, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Blueprint Medicines, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, EMD Serono Inc, Exelixis Inc, Foundation Medicine, Genentech, Genmab, Genomic Health Inc, Gilead Sciences Inc, Guardant Health, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Loxo Oncology Inc, a wholly owned subsidiary of Eli Lilly & Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, Natera Inc, Novartis, Oncopeptides, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sandoz Inc, a Novartis Division, Sanofi Genzyme, Seattle Genetics, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro, A GSK Company, Teva Oncology, Tokai Pharmaceuticals Inc and Tolero Pharmaceuticals.

    RESEARCH TO PRACTICE CME PLANNING COMMITTEE MEMBERS, STAFF AND REVIEWERS — Planners, scientific staff and independent 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 grantor.

    This activity is supported by an educational grant from AstraZeneca.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
    Adobe Flash Player 27 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Release date: February 2020
    Expiration date: February 2021

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