Lung Cancer CME ACCREDITED Watch Time: 42 mins

touchMDT Navigating diagnostic considerations and treatment options in NSCLC: A multidisciplinary approach

Watch leading experts involved in the multidisciplinary management of patients with advanced NSCLC discuss the importance of the initial assessment and key considerations for treatment choices within a rapidly evolving landscape.

Overview & Learning Objectives

The MDT navigates diagnostic and treatment considerations for patients with NSCLC. How do recent advances change what we do?

Medical Oncologist and Radiation Oncologist

A medical oncologist and radiation oncologist discuss the importance of the initial assessment in NSCLC.

Expert Spotlight
Dr Alexander Drilon
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Prof. Andrea Bezjak
Princess Margaret Cancer Center & University of Toronto, Toronto, Canada

Dr Alexander Drilon and Prof. Andrea Bezjak discuss the importance of a multidisciplinary approach from the initial assessment of patients with NSCLC and highlight the key considerations for accurate disease staging, radiological assessment and the implications for treatment decisions.

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Learn more Back to MDT Hub Time: 10:16
 
Medical Oncologist and Pathologist

A medical oncologist and pathologist talk about the evolving role of biomarker testing in NSCLC.

Expert Spotlight
Dr Alexander Drilon
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Prof. Keith Kerr
Aberdeen Royal Infirmary & Aberdeen University Medical School, Aberdeen, Scotland, UK

Dr Alexander Drilon and Prof. Keith Kerr talk about current guidelines for biomarker testing, the advantages and disadvantages of liquid versus tissue biopsy and how biomarker testing can be used to support treatment decision making in NSCLC.

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Learn more Back to MDT Hub Time: 10:29
 
Medical Oncologist, Pathologist and Oncology Nurse Practitioner

A medical oncologist, oncology nurse practitioner and pathologist discuss how treatment decisions need to take into account potential side effects.

Expert Spotlight
Dr Alexander Drilon
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Prof. Keith Kerr
Aberdeen Royal Infirmary & Aberdeen University Medical School, Aberdeen, Scotland, UK
Dr Marianne Davies
Yale School of Nursing, New Haven, CT, USA

Dr Alexander Drilon, Dr Marianne Davies and Prof. Keith Kerr consider the factors that may impact treatment choices, especially in the light of new and emerging targeted therapies for advanced NSCLC.

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Learn more Back to MDT Hub Time: 10:54
 
Medical Oncologist, Pathologist, Oncology Nurse Practitioner and Radiation Oncologist

Four specialists from the MDT discuss how to optimize treatment decisions, taking into account emerging therapies as well patient expectations and preferences.

Expert Spotlight
Dr Alexander Drilon
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Prof. Keith Kerr
Aberdeen Royal Infirmary & Aberdeen University Medical School, Aberdeen, Scotland, UK
Dr Marianne Davies
Yale School of Nursing, New Haven, CT, USA
Prof. Andrea Bezjak
Princess Margaret Cancer Center & University of Toronto, Toronto, Canada

Dr Alexander Drilon, Dr Marianne Davies, Prof. Keith Kerr and Prof. Andrea Bezjak discuss the critical role of the multidisciplinary team in optimizing treatment decisions for patients with advanced NSCLC and the need for personalized patient care.

Listen on the go

Learn more Back to MDT Hub Time: 10:23
 
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Overview & Learning Objectives
Overview

In this activity, specialists involved in the management of patients with advanced NSCLC share their perspectives on the role of the multidisciplinary team (MDT) in the diagnosis and treatment of NSCLC, the role of biomarker testing and how emerging treatment choices are impacting clinical decision making.

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, radiation oncologists, thoracic surgeons, pathologists and oncology nurse specialists involved in the management of NSCLC worldwide.

Disclosures

USF Health adheres to ACCME Standards regarding commercial support of continuing medical education. It is the policy of USF Health that the faculty and planning committee disclose real or apparent conflicts of interest relating to the topics of this educational activity, that relevant conflict(s) of interest are resolved and also that faculty will disclose any unlabeled/unapproved use of drug(s) or device(s) during their presentation.

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 Alexander Drilon discloses: Advisory board or panel fees from AbbVie, AstraZeneca, Axis Pharma, Bayer/Eli Lilly (Loxo), BeiGene, BerGenBio, Blueprint Medicines, Chugai Pharmaceutical Co. Ltd, Elevation Oncology (formerly 14ner Oncology), EMD Serono Inc., Exelixis, Genentech/Roche (Ignyta), Harborside, Helsinn Healthcare, Hengrui Therapeutics Inc.,  Melendi, Merus, Monopteros Therapeutics, Novartis, Nuvalent, Pfizer, Remedica Ltd., Repare Therapeutics, Takeda (Millenium/Ariad), Turning Point Therapeutics, Tyra Biosciences and Verastem Oncology. Associated research (paid to institution) from Exelixis, GlaxoSmithKlein, Pfizer, PharmaMar, Taiho Pharmaceutical Co. Ltd. and Teva Pharmaceuticals. Other royalties from Boehringer Ingelheim, Merck, Merus and Puma Biotechnology.

Prof. Andrea Bezjak discloses: Advisory board or panel fees from AstraZeneca. Speaker’s bureau fees from AstraZeneca.

Prof. Keith Kerr discloses: Advisory board or panel fees from AbbVie, AstraZeneca, Bayer (terminated), Boehringer Ingelheim, Celgene, Debiopharm Group, Eli Lilly, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron and Roche. Speaker’s bureau fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche and Ventana Medical Systems.

Dr Marianne Davies discloses: Speaker’s bureau fees from Bristol Myers Squibb, Genentech and Merck & Co., Inc (terminated).

Content reviewer

Alicia Ann Canalejo, MSN, ARNP-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has 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 credit 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 hour 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.

ILNA

The program content has been reviewed by the Oncology Nursing Certification Corporation (ONCC) and is acceptable for recertification points.

Disclaimer: ONCC review is only for designating content to be used for ILNA points and is not for NCPD accreditation. NCPD programs must be formally approved for contact hours by an acceptable accreditor/approver of nursing NCPD to be used for recertification by ONCC. If the NCPD provider fails to obtain formal approval to award contact hours by an acceptable accrediting/approval body, no information related to ONCC recertification or ILNA categories may be used in relation to the program.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 10 November 2021. Date credits expire: 10 November 2022.

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

Learning Objectives

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

  • Discuss the significance of the MDT for prompt and effective diagnosis and treatment selection in NSCLC
  • Evaluate the utility of broad molecular profiling and companion diagnostics within the context of current recommendations for molecular testing in NSCLC
  • Recall the latest therapeutic developments in advanced NSCLC and implications for MDT clinical decision making
Faculty & Disclosures
Dr Alexander Drilon

Memorial Sloan Kettering Cancer Center, New York, NY, USA

Alexander Drilon, MD, is the Chief of the Early Drug Development Service and an Associate Attending Physician of the Thoracic Oncology Service at Memorial Sloan Kettering Cancer Center in New York, USA. read more

Dr Drilon’s research focuses on the development of targeted therapy for genomic subsets of lung cancer and other solid tumours, including cancers that harbour fusions involving ALK, ROS1, RET and NTRK1/2/3, and MET exon 14 skipping alterations.

He is a recipient of the American Society for Clinical Oncology (ASCO)/Conquer Cancer Foundation Career Development and Young Investigator Awards, and grants from the International Association for the Study of Lung Cancer and the Lung Cancer Research Foundation. Dr Drilon is also a member of the editorial board of the ASCO University.

Dr Alexander Drilon discloses: Advisory board or panel fees from AbbVie, AstraZeneca, Axis Pharma, Bayer/Eli Lilly (Loxo), BeiGene, BerGenBio, Blueprint Medicines, Chugai Pharmaceutical Co. Ltd, Elevation Oncology (formerly 14ner Oncology), EMD Serono Inc., Exelixis, Genentech/Roche (Ignyta), Harborside, Helsinn Healthcare, Hengrui Therapeutics Inc.,  Melendi, Merus, Monopteros Therapeutics, Novartis, Nuvalent, Pfizer, Remedica Ltd., Repare Therapeutics, Takeda (Millenium/Ariad), Turning Point Therapeutics, Tyra Biosciences and Verastem Oncology. Associated research (paid to institution) from Exelixis, GlaxoSmithKlein, Pfizer, PharmaMar, Taiho Pharmaceutical Co. Ltd. and Teva Pharmaceuticals. Other royalties from Boehringer Ingelheim, Merck, Merus and Puma Biotechnology.

Prof. Andrea Bezjak

Princess Margaret Cancer Center & University of Toronto, Toronto, Canada

Andrea Bezjak, BMedSc, MDCM, MSc, FRCPC, is a Professor in the departments of Radiation Oncology and Clinical Epidemiology & Health Care Research at the University of Toronto, Canada and Staff Radiation Oncologist at the Princess Margaret Cancer Center/University Health Network. read more

Prof. Bezjak has held a number of leadership positions at Princess Margaret Hospital, including Cancer Program Site Group Leader (2009–2016) and the inaugural Addie MacNaughton Chair in Thoracic Radiation Oncology (2004–2019).

She has authored or co-authored more than 240 peer-reviewed manuscripts and has been a principal investigator of multicentre clinical trials in lung cancer.

Prof. Bezjak’s current positions include being the Radiation Oncology Residency Program Director at the University of Toronto, Medical Director of the Princess Margaret Cancer Care Network, Board Member and Secretary of the Board of the International Association for the Study of Lung Cancer and Secretary (previously Chair) of the Canadian Radiation Oncology Foundation.

Prof. Andrea Bezjak discloses: Advisory board or panel fees from AstraZeneca. Speaker’s bureau fees from AstraZeneca.

Prof. Keith Kerr

Aberdeen Royal Infirmary & Aberdeen University Medical School, Aberdeen, Scotland, UK

Keith Kerr, BSc, MB, ChB, FRCPath, FRCPE, is a Consultant Pathologist for NHS Grampian and Honorary Chair in Pulmonary Pathology at the University of Aberdeen in Scotland, UK. read more

Prof. Kerr is Chair of the International Association for the Study of Lung Cancer (IASLC) Pathology Panel and served on the IASLC Board of Directors from 2013 to 2017. He received the IASLC Mary Matthews award for Pathology and Translational Research in 2016, and the Lifetime Achievement award from the British Thoracic Oncology Group in 2019.

Prof. Kerr is a member of the European Society of Medical Oncology Lung/Thoracic Educational Faculty, is Pathology Chair for the European Thoracic Oncology Platform Lungscape group, and was a member of the panel (author/editor) for the 2004, 2015 and 2020 World Health Organization lung cancer classifications.

He has worked on numerous clinical research lung cancer trials groups, guideline panels and conference scientific committees. He is an associate editor for the Journal of Thoracic Oncology. He received an Honorary Fellowship of the Royal College of Physicians of Edinburgh in 2006 and Honorary Fellow of the Faculty of Pathology, Royal College of Physicians of Ireland in 2016.

Prof. Keith Kerr discloses: Advisory board or panel fees from AbbVie, AstraZeneca, Bayer (terminated), Boehringer Ingelheim, Celgene, Debiopharm Group, Eli Lilly, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron and Roche. Speaker’s bureau fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Serono, Merck Sharp & Dohme, Novartis, Pfizer, Roche and Ventana Medical Systems.

Dr Marianne Davies

Yale School of Nursing, New Haven, CT, USA

Marianne Davies, DNP, ACNP, AOCNP, FAAN, is a board-certified Acute Care Nurse Practitioner. She is a graduate of Yale University School of Nursing (MSN-Oncology Clinical Nurse Specialist and Post-Masters-Acute Care Nurse Practitioner) and MGH Institute of Health Professions (Doctorate of Nursing Practice). She is an Associate Professor at Yale School of Nursing and coordinates the Oncology Nurse Practitioner Concentration. read more

Her clinical practice is at the Yale Comprehensive Cancer Center-Medical Oncology Division, with specialization in immunotherapy, targeted therapies and management of associated toxicities. She is a member of the Advanced Practitioner Society for Hematology and Oncology, Oncology Nursing Society, International Association for the Study of Lung Cancer, International Thoracic Oncology Nursing Forum, Society for Immunotherapy of Cancer, Association of Community Care Centers Institute for Clinical Immuno-Oncology, National Comprehensive Cancer Network and AIM with Immunotherapy Foundation.

Dr Davies serves on the Immunotherapy Guideline Development Boards of the Society of Immunotherapy of Cancer, the National Comprehensive Cancer Network and the American Society of Clinical Oncology. She has published and presented extensively on the topics of lung cancer, immunotherapy, targeted therapy and symptom management. She was recently inducted as a Fellow in the American Academy of Nursing (FAAN-2020).

Dr Marianne Davies discloses: Speaker’s bureau fees from Bristol Myers Squibb, Genentech and Merck & Co., Inc (terminated).

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Question 1/5
Your patient is a 71-year-old male diagnosed with stage IV NSCLC, which has been confirmed by histological examination. The case is discussed at your institution’s multidisciplinary tumour board meeting. Assuming all options are available at your institution and according to NCCN guidelines, which of the following examinations would you recommend to assess for brain metastases and guide appropriate therapeutic intervention?

CT, computed tomography; MRI, magnetic resonance imaging; NCCN, National Comprehensive Cancer Network; NSCLC, non-small cell lung carcinoma; PET, positron-emission tomography
Correct

Brain MRI with contrast is recommended by NCCN guidelines to rule out asymptomatic brain metastases in patients with stage II, III and IV NSCLC if aggressive combined-modality therapy is being considered. A CT scan of the head with contrast is an option, but only if a brain MRI cannot be done. PET scans are not recommended for assessing whether brain metastases are present.

Abbreviations

CT, computed tomography; MRI, magnetic resonance imaging; NCCN, National Comprehensive Cancer Network; NSCLC, non-small cell lung carcinoma; PET, positron-emission tomography.

Reference

NCCN Clinical Practice Guidelines in Oncology, Non-Small Cell Lung Cancer, Version 6.2021, September 30, 2021. Available at: www.nccn.org/professionals/physician_gls/pdf/nscl.pdf (accessed 6 October 2021).

Question 2/5
Which of the following statements about molecular biomarker analysis using liquid biopsy is correct?

NGS, next-generation sequencing.
Correct

Tissue biopsy remains the ‘gold standard’ for biomarker testing in NSCLC.1 Liquid biopsy can be useful if there is insufficient tumour tissue at diagnosis, and may be advantageous if there is a contraindication for biopsy (e.g. bleeding risk). Liquid biopsy can also be utilized if re-biopsy of tumour tissue is not possible during first-line treatment and there is a need to test for a biomarker relevant to second-line treatment.1

One of the advantages of liquid versus tissue biopsy is that, when histological samples are not required, the turnaround time to obtain NGS results is, in most situations, faster with a liquid biopsy than when processing a tissue biopsy, which may allow earlier administration of a targeted treatment in the case of rapid tumour progression.2 It is important to note that these are complementary rather than competing tools for molecular biomarker analysis.1

Abbreviations

NGS, next-generation sequencing; NSCLC, non-small cell lung cancer.

References

  1. Kerr KM, et al. Lung Cancer. 2021;154:161–75.
  2. Hofman P. Cancers (Basel). 2021;13:2049.
Question 3/5
Your patient is a 70-year-old male who has been diagnosed with advanced NSCLC and has received platinum-based doublet chemotherapy. Broad biomarker testing was performed by NGS and results indicated a KRASG12C mutation. Based on FDA approval status, which of the following agents would you consider for targeted therapy?

FDA, US Food and Drug Administration; KRAS, Kirsten rat sarcoma viral oncogene homolog; NGS, next-generation sequencing; NSCLC, non-small cell lung cancer.
Correct

Sotorasib is an inhibitor of the Ras GTPase family and was approved in May 2021 by the FDA for the treatment of adult patients with KRASG12C-mutated locally advanced or metastatic NSCLC, who have received at least one prior therapy.1

Tepotinib is indicated for the treatment of adult patients with metastatic NSCLC harbouring MET-exon14 skipping alterations.2 Entrectinib is indicated for the treatment of metastatic ROS1-mutant NSCLC.,3  Repotrectinib is a next-generation ROS1/TRK/ALK-TKI which is currently under phase I/II clinical trial.4

These agents represent some of the emerging therapeutic agents and ongoing clinical trials in advanced NSCLC.

Abbreviations

ALK, anaplastic lymphoma kinase; FDA, US Food and Drug Administration; KRAS, Kirsten rat sarcoma viral oncogene homolog; MET, mesenchymal-epithelial transition; NSCLC, non-small cell lung cancer; ROS1, c-ros oncogene 1; TKI, tyrosine kinase inhibitor; TRK, tyrosine kinase.

References

  1. FDA. Sotorasib prescribing information. 2021. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/214665s000lbl.pdf (accessed 12 October 2021).
  2. FDA. Tepotinib prescribing information. 2021. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/214096s000lbl.pdf (accessed 12 October 2021).
  3. FDA. Entrectinib prescribing information. 2019. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2019/212726s000lbl.pdf (accessed 12 October 2021).
  4. Yun MR, et al. Clin Cancer Res. 2020;26:3287–95.
Question 4/5
For which of the following patients with advanced/metastatic NSCLC would you consider targeted therapy as a suitable treatment option?

ALK, anaplastic lymphoma kinase; EML4, echinoderm microtubule-associated protein like protein 4; NSCLC, non-small cell lung cancer; PD-L1, programmed death-ligand 1; TPS, tumour proportion score.
Correct

Both NCCN and ESMO guidelines recommend targeted therapies for patients with advanced/metastatic NSCLC whose tumour bears an actionable oncogenic driver mutation, irrespective of PD-L1 expression.1,2 Smoking status has been shown to influence the efficacy and tolerability of different treatments for lung cancer.3 Different targeted therapies have demonstrated clinical benefit in both smokers and non-smokers, including those with ALK-mutant tumour.3 However, smoking status is not currently a factor influencing the choice of targeted therapy in patients whose tumour bears an actionable oncogenic driver mutation according to national/international guidelines.1,2

Abbreviations

ALK, anaplastic lymphoma kinase; ESMO, European Society for Medical Oncology; NCCN, National Comprehensive Cancer Network; NSCLC, non-small cell lung cancer; PD-L1, programmed death-ligand 1.

References

  1. NCCN Clinical Practice Guidelines in Oncology, Non-Small Cell Lung Cancer, Version 6.2021, September 30, 2021. Available at: www.nccn.org/professionals/physician_gls/pdf/nscl.pdf (accessed 6 October 2021).
  2. Planchard D, et al. Ann Oncol. 2018;29(Suppl. 4):iv192–237. 2020 update available at: www.esmo.org/guidelines/lung-and-chest-tumours/clinical-practice-living-guidelines-metastatic-non-small-cell-lung-cance  (accessed 14 October 2021).
  3. Li X, et al. J Clin Pharm Ther. 2021;46:256–66.
Question 5/5
Which of the following statements best describes the optimal role of a specialist oncology nurse within the MDT for the delivery of targeted therapy to patients with advanced NSCLC?

MDT, multidisciplinary team; NSCLC, non-small cell lung cancer.
Correct

Lung cancer nurse specialists are advanced practice nurses providing continuity of care across the cancer pathway and offering expertise within multidisciplinary settings.1 Descriptive studies support the role of the lung cancer nurse specialist in advocating treatment and reducing emergency admissions for people with lung cancer.1

Evidence supports the involvement of oncology specialist nurses from diagnosis and throughout the patient’s journey.1 A recent study conducted in the UK showed that receiving a lung cancer nurse specialist assessment before/at diagnosis was associated with improved patient outcomes compared with those receiving assessment after diagnosis.1

Specialist oncology nurses play a crucial role in monitoring side effects; coordinating the involvement of physicians outside of the core MDT; and facilitating optimal preparation of patients for, and support during, treatment.2 The role of the specialist nurse extends to all treatment pathways, including targeted therapy. For example, the recently published ‘Consensus Recommendations for Management and Counseling of Adverse Events Associated With Lorlatinib’ states that nurses, together with other HCPs, should provide proactive counselling, monitoring and effective management of treatment-related adverse events.3

Abbreviations

HCP, healthcare professional; MDT, multidisciplinary team.

References

  1. Stewart I, et al. Int J Nurs Stud. 2021;118:103718.
  2. Popat S, et al. Oncologist. 2021;26:e306–15.
  3. Reed M, et al. Adv Ther. 2020;37:3019–30.
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