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    Faculty & Disclosures
    Dr Ian Chau

    Royal Marsden Hospital, London, UK

    Dr Ian Chau is a consultant medical oncologist within the Gastrointestinal and Lymphoma Units at Royal Marsden Hospital and professor at the Institute of Cancer Research, London and Surrey, UK. He is the chief or principal investigator of multiple phase I, II and III clinical trials evaluating novel treatment strategies and agents in various cancer signalling pathways. read more

    Dr Chau serves or has served on the American Society of Clinical Oncology (ASCO) Scientific Program Committee, ASCO Education Committee, European Society of Medical Oncology (ESMO) Congress Steering Committee, ESMO Asia Scientific Programme and Steering Committee, ESMO Educational Committee, Japanese Society of Medical Oncology (JSMO) International Steering Committee and UK National Cancer Research Institute (NCRI) Colorectal Cancer and Pancreatic Cancer Clinical Study Groups.

    He also serves or has served on the UK National Institute of Health and Care Excellence (NICE) Clinical Guideline Development Group for non-Hodgkin’s Lymphoma, ASCO Expert Panel for the Management of Immunotherapy Toxicities Guideline and ESMO Clinical Practice Guidelines for Hepatocellular Carcinoma panel. He is the recipient of the Swedish Society of GI Oncology Bengt Glimelius Award 2016, merit awards from ASCO Gastrointestinal Cancer Symposium, The Royal Society of Medicine Section of Oncology Clinical Prize, fellowships from the European School of Oncology and ASCO/AACR/FECS Clinical Cancer Research Workshop.

    Dr Chau has given invited lectures in over 30 countries. He has served on international drug development advisory boards and has peer-reviewed publications in the New England Journal of Medicine, The Lancet, The Lancet Oncology, Journal of Clinical Oncology and other leading oncology/biomedical journals.

    Dr Ian Chau discloses: Advisory board/panel fees from Astellas Inc., AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Incyte, Merck-Serono, MSD, OncXerna, Pierre Fabre, Roche, Seagen, Servier, Sotio, Taiho and Turning Point Therapeutics. Consultant for Bristol Myers Squibb, Eisai, Eli Lilly, Roche and Servier. Grants/research support from Eli Lilly and Janssen Cilag.
    Dr Antonia Sepulveda

    George Washington University, Washington, DC, USA

    Dr Antonia Sepulveda is professor and chair of the Department of Pathology at George Washington University and medical director of George Washington University Hospital Laboratories, Washington, DC, USA. She is an expert in gastrointestinal pathology and genomic and molecular diagnostic pathology. read more

    Dr Sepulveda’s leadership is nationally and internationally recognized. She was the lead co-chair for the Molecular testing guidelines for colorectal cancer published in 2017, a combined initiative of the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology and the American Society of Clinical Oncology. She is a member of the Colon Cancer Taskforce of the National Cancer Institute (NCI) Gastrointestinal Cancers Steering Committee.

    Dr Sepulveda’s research is focused on innovative genomics, transcriptomics and computational image analyses of cancers and pre-cancer lesions. She has over 160 publications (original research, reviews, chapters and books) and is a sought-out speaker.

    Dr Sepulveda has held many leadership positions and was the 2021 president and chair of the Board of Directors of the Association for Molecular Pathology.

    Dr Antonia Sepulveda discloses: Advisory board/panel fees from Merck (Relationship Terminated).
    Dr Silvia Marsoni

    IFOM ETS, Milan, Italy

    Dr Silvia Marsoni is an internationally recognized leader in clinical trial design in oncology. She has developed a broad background in designing, implementing and conducting master translational protocols for clinical pipelines and therapeutic proof-of-concept trials, with a special focus on colorectal cancer. read more

    Her latest designed trial, PEGASUS, uses interventional post-surgery liquid biopsy to triage adjuvant treatment in patients with early colon cancer and will serve as a platform for deciphering cancer evolution in space and time.

    Dr Silvia Marsoni has no interests/relationships or affiliations to disclose in relation to this activity.
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    touchPANEL DISCUSSION
    A visually engaging discussion designed to emulate a ‘live’ panel experience and provide clinicians with practical expert insights to address their clinical challenges. Useful tips below will show how to navigate the activity. Close

    What are the implications of the latest data for HER2-targeted therapies in HER2-tested patients with colorectal cancer?

    Faculty Podcast Featured
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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Explain the testing methods used to identify patients with human epidermal growth factor receptor 2-positive (HER2+) colorectal cancer (CRC) and the interpretation of the results
    • Summarize the current guidelines for managing patients with HER2+ CRC
    • Discuss the recent efficacy and safety data for HER2-targeted agents in CRC
    Overview

    In this activity, three experts discuss the latest guidelines for identifying and treating patients with HER2+ CRC, as well as the efficacy and safety data for HER2-targeted agents and their impact on clinical practice. The discussion is guided by pre-canvassed questions provided by healthcare professionals involved in the management of patients with CRC.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    This activity has been designed to meet the educational needs of oncologists, pathologists and oncology nurses involved in the management of colorectal cancer.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Ian Chau discloses: Advisory board/panel fees from Astellas Inc., AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Incyte, Merck-Serono, MSD, OncXerna, Pierre Fabre, Roche, Seagen, Servier, Sotio, Taiho and Turning Point Therapeutics. Consultant for Bristol Myers Squibb, Eisai, Eli Lilly, Roche and Servier. Grants/research support from Eli Lilly and Janssen Cilag.

    Dr Antonia Sepulveda discloses: Advisory board/panel fees from Merck (Relationship Terminated).

    Dr Silvia Marsoni has no interests/relationships or affiliations to disclose in relation to this activity.

    Content reviewer

    Bailey Blankenship, APRN has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Directors

    Hannah Fisher, Sadaf Kazi and Christina Mackins-Crabtree have no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Nurses

    USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

    A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

    This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

    Date of original release: 13 December 2022. Date credits expire: 13 December 2024.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Colorectal Cancer / Gastrointestinal Cancers
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    This Activity Is Funded By:

    An independent medical education grant from Seagen Inc. This activity is jointly provided by USF Health and touchIME.

    The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CE to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 13 December 2022. Date credits expire: 13 December 2024.

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    touchPANEL DISCUSSION
    What are the implications of the latest data for HER2-targeted therapies in HER2-tested patients with colorectal cancer?
    0.75 CE/CME credit
    Question 1/5
    HER2 testing is carried out via immunohistochemistry on your 60-year-old male patient with metastatic CRC. According to the 2022 NCCN guidelines, when are the results considered to be positive?

    CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network.

    According to 2022 NCCN guidelines, HER2 positivity by immunochemistry is defined as 3+ staining in more than 50% of tumour cells. Classification of 3+ staining is an intense membrane staining that can be circumferential, basolateral or lateral.1,2

    Abbreviations

    HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network.

    References

    1. NCCN. Clinical Practice Guidelines in Oncology 2022. Colon cancer. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/colon.pdf (accessed 22 November 2022).
    2. NCCN. Clinical Practice Guidelines in Oncology 2022. Rectal cancer. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/rectal.pdf (accessed 22 November 2022).
    Question 2/5
    Your patient with RAS and BRAF wild-type, HER2-amplified metastatic CRC is not a candidate for intensive therapy. Based on the 2022 NCCN guidelines, what could you recommend as an initial therapy option?

    BRAF, v-Raf murine sarcoma viral oncogene homolog B1; CRC, colorectal cancer; FOLFIRI, leucovorin calcium (folinic acid), fluorouracil, and irinotecan hydrochloride; FOLFOX, leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; RAS, rat sarcoma virus.

    According to NCCN guidelines, for patients with previously untreated HER2-amplified metastatic CRC who are not candidates for intensive therapy, dual anti-HER2 therapy of trastuzumab + lapatinib or trastuzumab + pertuzumab is recommended.1,2

    Abbreviations

    CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network.

    References

    1. NCCN. Clinical Practice Guidelines in Oncology 2022. Colon cancer. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/colon.pdf (accessed 22 November 2022).
    2. NCCN. Clinical Practice Guidelines in Oncology 2022. Rectal cancer. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/rectal.pdf (accessed 22 November 2022).
    Question 3/5
    Your patient has HER2+, RAS and BRAF wild-type metastatic CRC. They have previously been treated with FOLFOX + bevacizumab as initial therapy and FOLFIRI + cetuximab as second-line therapy. According to the 2022 ESMO and 2022 NCCN guidelines, which of the following may be appropriate for their next line of treatment?

    BRAF, v-Raf murine sarcoma viral oncogene homolog B1; CRC, colorectal cancer; ESMO, European Society for Medical Oncology; FOLFIRI, leucovorin calcium (folinic acid), fluorouracil, and irinotecan hydrochloride; FOLFOX, leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; RAS, rat sarcoma virus.

    According to the 2022 ESMO clinical practice guideline for the diagnosis, treatment and follow-up of metastatic colorectal cancer, for third- and further-line treatment in patients with HER2+ metastatic CRC, treatment with trastuzumab + lapatinib, trastuzumab + pertuzumab or trastuzumab deruxtecan is recommended, especially in RAS wild-type tumours.1 According to the 2022 NCCN guidelines, trastuzumab + lapatinib/pertuzumab or trastuzumab deruxtecan can be considered for patients with HER2-amplified, RAS and BRAF wild-type, advanced/metastatic CRC in the third-line setting.2,3

    Abbreviations

    CRC, colorectal cancer; ESMO, European Society for Medical Oncology; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; RAS, rat sarcoma virus.

    References

    1. Cervantes A, et al. Ann Oncol. 2022; https://doi.org/10.1016/j.annonc.2022.10.003.
    2. NCCN. Clinical Practice Guidelines in Oncology 2022. Colon cancer. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/colon.pdf (accessed 22 November 2022).
    3. NCCN. Clinical Practice Guidelines in Oncology 2022. Rectal cancer. Version 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/rectal.pdf (accessed 22 November 2022).
    Question 4/5
    In the phase II MOUNTAINEER trial evaluating the efficacy and safety of the investigational combination of trastuzumab with tucatinib in patients with previously treated HER2+ and RAS wild-type metastatic CRC, what was the median overall survival rate?

    CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2; RAS, rat sarcoma virus.

    In the phase II MOUNTAINEER trial, 86 patients with previously treated HER2+ metastatic CRC had a median overall survival of 24.1 months when treated with trastuzumab in combination with tucatinib.1

    Abbreviations

    CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2.

    Reference

    1. Strickler JH, et al. Presented at: ESMO World Congress on Gastrointestinal Cancer. 29 June–2 July 2022 Abstr LBA-2.

    Question 5/5
    Your patient with HER2+ metastatic CRC has just started trastuzumab deruxtecan monotherapy. What should you do as part of this patient's follow-up?

    CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2; MRI, magnetic resonance imaging.

    Interstitial lung disease and pneumonitis are important risks associated with trastuzumab deruxtecan. These diseases are also associated with irinotecan and other HER2-targeted therapies, such as trastuzumab and trastuzumab emtansine.1 Close monitoring for early signs and symptoms is advised for early detection. In the DESTINY-CRC01 clinical trial, as soon as interstitial lung disease was suspected, treatment was interrupted or discontinued, imaging was conducted (as clinically indicated) and glucocorticoids were given.2

    Abbreviation

    HER2, human epidermal growth factor receptor 2.

    References

    1. Siena S, et al. Lancet Oncol. 2021;22:779–89.
    2. Yoshino T, et al. Presented at: ASCO 2021 Annual Meeting. 4–8 June 2021.
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    This Activity Is Funded By:

    An independent medical education grant from Seagen Inc. This activity is jointly provided by USF Health and touchIME.

    The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CE to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 13 December 2022. Date credits expire: 13 December 2024.

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