TARGET AUDIENCE
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.

OVERVIEW OF ACTIVITY
CNS metastases are detectable in 10% to 20% of patients initially presenting with non-small cell lung cancer (NSCLC), with an even higher incidence noted in oncogene-addicted tumor subsets such as disease with epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements. In addition, leptomeningeal metastasis represents a unique clinical entity that occurs in 3% to 5% of patients with advanced NSCLC. CNS metastases are associated with poor prognosis and significant morbidity and present a major therapeutic challenge in the management of NSCLC. Historically, local therapies, including whole-brain radiation therapy, stereotactic radiosurgery or a combination of neurosurgery and radiation therapy, have been the standard approaches, but despite initial responses, distant CNS recurrence is common. More recently the management of CNS metastases has been reshaped for the molecularly defined subpopulations of patients with NSCLC with EGFR mutations or ALK rearrangements, in which systemic targeted tyrosine kinase inhibitor (TKI) therapies have shown superior intracranial outcomes.

To ensure state-of-the-art and individualized care for patients with NSCLC and brain metastases, it is essential that clinicians in practice are updated on the safety and efficacy profiles of the novel TKIs and provided with experienced insights into how these therapies can be optimally integrated into the interdisciplinary management paradigm. To this end, this CME activity features a one-on-one discussion with a leading lung cancer investigator and offers neuro-oncologists and general medical oncologists in the community an expert viewpoint on the novel therapeutic approaches emerging in the management of NSCLC with CNS metastases.

LEARNING OBJECTIVES

• Use patient- and disease-specific factors, such as performance status, presence of an activating tumor mutation, number and location of lesions, et cetera, to identify the most appropriate local therapy technique for the management of brain metastases in individuals with NSCLC.
• Appraise the relative degrees of CNS permeability with various TKIs and the corresponding efficacy of these agents against NSCLC 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 to discern how this information should be applied to current patient care.
• Evaluate the activity of FDA-endorsed ALK inhibitors in patients with NSCLC with ALK rearrangements and CNS metastases to optimize the selection and sequencing of targeted treatments.
• Appreciate available clinical trial data and the rationale for ongoing clinical trials evaluating anti-PD-1/PD-L1 antibodies for NSCLC with brain metastases, and use this information to appropriately counsel patients about protocol and off-protocol treatment options.

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
CME credit is no longer available for this issue

AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) — MAINTENANCE OF CERTIFICATION (MOC)
CME credit is no longer available for this issue

HOW TO USE THESE CME ACTIVITIES
Audio Program: This CME activity consists of an audio component.
CME credit is no longer available for this issue

Video Program: This CME activity consists of a video component.
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 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 his spouse/partner) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process: 

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.

EDITOR — 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.

These educational activities contain 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