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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?

  • Downloads including slides are available for this activity in the Toolkit
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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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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