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Colorectal Cancer, Gastrointestinal Cancers CE/CME ACCREDITED Watch Time: 47 mins

touchMDT How can HER2-targeted therapies be incorporated into the management of patients with CRC?

Hear multidisciplinary team and patient perspectives on the management of HER2-positive colorectal cancer.

 Overview & Learning Objectives

Patient with HER2+ CRC
Medical Oncologist & Pathologist
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HER2 testing Prof. Andrea Sartore-Bianchi, Dr Evgeny Yakirevich

A medical oncologist and a pathologist discuss HER2 testing in patients with CRC.

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Medical Oncologist & Medical Oncologist
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HER2-targeted treatments for CRC Dr Kristen Ciombor, Prof. Andrea Sartore-Bianchi

Two medical oncologists discuss the latest clinical data for HER2-targeted therapies, their incorporation into CRC management and perspectives on the future of HER2-targeted therapies.

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Medical Oncologist & Advanced Practice Nurse & Patient Advocate
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MDT care for patients with CRC Dr Kristen Ciombor, Dr Kelley Rone, Mr Scott Wilson

A medical oncologist, advanced practice nurse and patient advocate share their views on how the MDT can support patients with HER2+ CRC.

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Medical Oncologist & Advanced Practice Nurse & Patient Advocate
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Managing CRC treatment side effects Dr Kristen Ciombor, Dr Kelley Rone, Mr Scott Wilson

A medical oncologist, advanced practice nurse and patient advocate discuss possible side effects of CRC treatments.

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Medical Oncologist & Pathologist

A medical oncologist and a pathologist discuss HER2 testing in patients with CRC.
Expert Spotlight
Prof. Andrea Sartore-Bianchi
Niguarda Cancer Center, Milan, Italy
Dr Evgeny Yakirevich
Rhode Island Hospital, Providence, RI, USA

Oncologist Prof. Andrea Sartore-Bianchi and pathologist Dr Evgeny Yakirevich discuss testing approaches for HER2 in CRC, including how, when and interpretation of results, and using a patient case to illustrate application in clinical practice.

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 Learn More Back to MDT Hub Time: 13:53
 
Medical Oncologist & Medical Oncologist

Two medical oncologists discuss the latest clinical data for HER2-targeted therapies, their incorporation into CRC management and perspectives on the future of HER2-targeted therapies.

Expert Spotlight
Dr Kristen Ciombor
Vanderbilt University Medical Center, Nashville, TN, USA
Prof. Andrea Sartore-Bianchi
Niguarda Cancer Center, Milan, Italy

Two oncologists, Dr Kristen Ciombor and Prof. Andrea Sartore-Bianchi, discuss the latest clinical trial data for HER2-targeted treatment, how they utilize HER2-targeted treatments in clinical practice, and what the future holds for HER2-targeting in CRC.

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 Learn More Back to MDT Hub Time: 11:53
 
Medical Oncologist & Advanced Practice Nurse & Patient Advocate

A medical oncologist, advanced practice nurse and patient advocate share their views on how the MDT can support patients with HER2+ CRC.
Expert Spotlight
Dr Kristen Ciombor
Vanderbilt University Medical Center, Nashville, TN, USA
Dr Kelley Rone
Mayo Clinic, Phoenix, AZ, USA
Mr Scott Wilson
Denver, CO, USA

Mr Scott Wilson, a patient advocate and CRC survivor, joins oncologist Dr Kristen Ciombor and advanced practice nurse Dr Kelley Rone to discuss how the MDT can support patients with HER2+ CRC.

Listen on the Go

 Learn More Back to MDT Hub Time: 12:43
 
Medical Oncologist & Advanced Practice Nurse & Patient Advocate

A medical oncologist, advanced practice nurse and patient advocate discuss possible side effects of CRC treatments.
Expert Spotlight
Dr Kristen Ciombor
Vanderbilt University Medical Center, Nashville, TN, USA
Dr Kelley Rone
Mayo Clinic, Phoenix, AZ, USA
Mr Scott Wilson
Denver, CO, USA

Oncologist Dr Kristen Ciombor and advanced practice nurse Dr Kelley Rone are joined by Mr Scott Wilson, a patient advocate and CRC survivor, to consider the management of possible side effects in the MDT setting.

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 Learn More Back to MDT Hub Time: 08:52
 
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Overview & Learning Objectives
Overview

In this activity, four experts involved in the management of patients with HER2+ CRC, plus a CRC survivor and patient advocate, share their perspectives on HER2 testing, utilizing HER2-targeted agents in clinical practice and optimizing care in the multidisciplinary team setting.

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 patients with CRC.

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

Prof. Andrea Sartore-Bianchi discloses:  Advisory board/panel fees from Amgen, Bayer and Novartis.

Dr Evgeny Yakirevich has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Kristen Ciombor discloses: Advisory board/panel fees from Incyte, Lilly/Loxo, Merck, Personalis, Pfizer, Replimune and Seagen. Consultant for Merck, Pfizer and Seagen. Grants/research support from Array, Bristol Myers Squibb, Daiichi Sankyo, Genentech, Incyte, Merck, Nucana, Pfizer/Calithera and Seagen.

Dr Kelley Rone has no interests/relationships or affiliations to disclose in relation to this activity.

Mr Scott Wilson 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 Director

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 1.0 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 1.0 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 1.0 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 1.0 ANCC pharmacotherapeutic contact hour.

Date of original release: 23 February 2023. Date credits expire: 23 February 2025.

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

Learning Objectives

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

  • Summarize how to test for HER2 amplifications in patients with CRC and how to interpret the results
  • Discuss how HER2-targeted agents can be incorporated into the management of patients with CRC
  • Outline how the multidisciplinary team can support patients with HER2+ CRC
Faculty & Disclosures
Prof. Andrea Sartore-Bianchi

Niguarda Cancer Center, Milan, Italy

Prof. Andrea Sartore-Bianchi is a medical oncologist at the Niguarda Cancer Center in Milan, Italy, where he is in charge of the Clinical Molecular Oncology Unit in the Department of Hematology, Oncology and Molecular Medicine. He is also associate professor of oncology at the University of Milan. read more

Prof. Sartore-Bianchi’s main clinical and research interests include precision oncology and the treatment of gastrointestinal cancers, particularly colorectal carcinomas, focusing on biomarkers of sensitivity/resistance to targeted therapies. He is principal and co-investigator in phase I, II and III clinical trials for solid tumours, and has carried out initial studies paving the way for the use of RAS and HER2 as tumour tissue/ctDNA biomarkers for metastatic colorectal cancer. Prof. Sartore-Bianchi has published 170 peer-reviewed articles in various medical journals.

Prof. Andrea Sartore-Bianchi discloses: Advisory board/panel fees from Amgen, Bayer and Novartis.
Dr Evgeny Yakirevich

Rhode Island Hospital, Providence, RI, USA

Dr Evgeny Yakirevich is a professor of pathology and laboratory medicine at the Warren Alpert Medical School of Brown University, and a staff pathologist at Lifespan Academic Medical Center in Providence, RI, USA. He serves as director of the Molecular Pathology Core Laboratory, Biorepository Core at Lifespan Academic Medical Center, and the Gastrointestinal and Liver Pathology Fellowship Program at Brown University. read more

Dr Yakirevich’s professional and research expertise is in the areas of gastrointestinal, liver, breast, thyroid and genitourinary pathology. Dr Yakirevich’s research interests are the relationships between molecular markers, including genomic alterations, RNA expression profiles and protein markers, and the clinical phenotype and long-term outcomes in cancer.

Dr Yakirevich is the author of more than 200 abstracts and research articles, and five book chapters. He serves on the editorial board of pathology and oncology journals.

Dr Evgeny Yakirevich has no interests/ relationships or affiliations to disclose in relation to this activity.
Dr Kristen Ciombor

Vanderbilt University Medical Center, Nashville, TN, USA

Dr Kristen Ciombor is an associate professor in the Division of Hematology/Oncology within the Department of Internal Medicine at the Vanderbilt University Medical Center, where she specializes in the treatment of patients with gastrointestinal cancers. read more

Dr Ciombor’s research involves the design and implementation of clinical trials for gastrointestinal malignancies, and colorectal cancer in particular. She also has a research interest in the genomics of colorectal cancer and translational medicine, and leads multiple national investigator-initiated clinical trials in this space.

Dr Ciombor is an integral member of the Vanderbilt-Ingram Cancer Center’s (VICC) Gastrointestinal Specialized Program of Research Excellence (GI SPORE), the Eastern Cooperative Oncology Group (ECOG) of which she serves as the Colorectal/Anal Working Group chair, the National Cancer Institute (NCI) Rectal-Anal Cancer Task Force; the National Comprehensive Cancer Network’s (NCCN) Anal, Colon, Rectal and Small Bowel Guidelines Panel, the International Rare Cancers Initiative (IRCI) Anal Cancer Working Group, the Academic GI Cancer Consortium (AGICC), the Colorectal Cancer Alliance Biomarker Think Tank Advisory Committee, and the Academic and Community Cancer Research United (ACCRU), of which she serves on the board of directors.

Dr Kristen Ciombor discloses: Advisory board/panel fees from Incyte, Lilly/Loxo, Merck, Personalis, Pfizer, Replimune and Seagen. Consultant for Merck, Pfizer and Seagen. Grants/research support from Array, Bristol Myers Squibb, Daiichi Sankyo, Genentech, Incyte, Merck, Nucana, Pfizer/Calithera and Seagen.
Dr Kelley Rone

Mayo Clinic, Phoenix, AZ, USA

Dr Kelley Rone is an advanced practice nurse in gastrointestinal oncology at the Mayo Clinic in Phoenix, AZ, USA. read more

Dr Rone’s early nursing career was spent in medical surgical oncology at several hospitals in the Dallas area, followed by outpatient oncology care with Texas Oncology. She spent 6 years working in cardiovascular intensive care while completing her education.

Caring for oncology patients was something that Dr Rone missed while working in critical care and returned to oncology when she entered the advanced practice field. Working at the Mayo clinic in Arizona has provided many opportunities to care for people who are profoundly affected by advanced cancers.

Dr Kelley Rone has no interests/relationships or affiliations to disclose in relation to this activity.
Mr Scott Wilson

Denver, CO, USA

Mr Scott Wilson was diagnosed with stage IV colon cancer with liver metastasis at the age of 48. After undergoing a colon resection and receiving chemotherapy, Mr Wilson was told he had “no evidence of disease” in August 2017. He subsequently underwent a liver resection and continues fortnightly maintenance immunotherapy to help prevent recurrence. read more

As a stage IV patient, Mr Wilson, like many others, lives “with the daily fear of recurrence”. He has taken his experiences and turned them into a platform to help educate and advocate for patients with colorectal cancer (CRC). Mr Wilson raises funds for the Colorectal Cancer Alliance, where he also volunteers to advocate for early onset CRC patients.

Mr Wilson continued his advocacy in his workplace as well. With the support of his company, free CRC screening was provided for all employees at Molson Coors headquarters regardless of age. He is also working with the Colorado Cancer Coalition to show the human and economic benefits of effective employee colorectal cancer screenings. His struggles and determination are helping to provide life-saving screenings without worry of cost or the possibility of being denied testing based on age. From little ripples with his personal relationships and large waves through his advocacy work, Mr Wilson is working to turn the tide of CRC.

Mr Scott Wilson has no interests/relationships or affiliations to disclose in relation to this activity.
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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: 23 February 2023. Date credits expire: 23 February 2025.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Which of the following patients with metastatic CRC would you test for HER2 amplification, as recommended by the 2022 ESMO and 2022 NCCN guidelines?

BRAF, v-Raf murine sarcoma viral oncogene homolog B1; CRC, colorectal cancer; ESMO, European Society for Medical Oncology; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; PIK3CA, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha; RAS, rat sarcoma virus.
 Correct

The 2022 ESMO clinical practice guidelines for the diagnosis, treatment and follow-up of metastatic CRC states that identification of HER2 amplification is recommended in RAS wild-type patients to detect those who may benefit from HER2 blockade.1 The 2022 NCCN guidelines recommend that HER2 testing is carried out in all patients unless there is a known RAS or BRAF mutation.2,3

Abbreviations

BRAF, v-Raf murine sarcoma viral oncogene homolog B1; 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. 2023;34:10–32.
  2. NCCN. Clinical Practice Guidelines in Oncology 2022. Colon cancer. Version 3.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/colon.pdf (accessed 27 January 2023).
  3. NCCN. Clinical Practice Guidelines in Oncology 2022. Rectal cancer. Version 4.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/rectal.pdf (accessed 27 January 2023).
Question 2/5
Which of the following statements is true regarding guideline-recommended HER2 testing methods in CRC?

CRC, colorectal cancer; ESMO, European Society for Medical Oncology; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; PCR, polymerase chain reaction.
 Correct

The 2022 ESMO clinical practice guidelines for the diagnosis, treatment and follow-up of metastatic CRC states that identification of HER2 amplification by immunohistochemistry or fluorescence in situ hybridization is recommended in RAS wild-type patients to detect those who may benefit from HER2 blockade.1 The 2022 NCCN guidelines recommend that diagnostic testing for HER2 is carried out via immunohistochemistry, fluorescence in situ hybridization or next-generation sequencing.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. 2023;34:10–32.
  2. NCCN. Colon cancer. Clinical Practice Guidelines in Oncology 2022. Colon cancer. Version 3.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/colon.pdf (accessed 31 January 2023).
  3. NCCN. Rectal cancer. Clinical Practice Guidelines in Oncology 2022. Rectal cancer. Version 4.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/rectal.pdf (accessed 31 January 2023).
Question 3/5
Your patient has RAS wild-type, HER2-amplified metastatic CRC that has progressed following fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy. Based on FDA approvals, which of the following would you consider as a second-line treatment option?

CRC, colorectal cancer; FDA, Food and Drug Administration; HER2, human epidermal growth factor receptor 2; RAS, rat sarcoma virus.
 Correct

On 19 January 2023, the FDA granted accelerated approval to tucatinib in combination with trastuzumab for RAS wild-type, HER2-positive, unresectable or metastatic CRC that has progressed following fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy.1

Trastuzumab emtansine, pyrotinib and zanidatamab are not currently approved to treat CRC, but they are under investigation as HER2-targeted CRC therapy options.2–4

Abbreviations

CRC, colorectal cancer; FDA, Food and Drug Administration; HER2, human epidermal growth factor receptor 2; RAS, rat sarcoma virus.

References

  1. Press release. Available at: www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tucatinib-trastuzumab-colorectal-cancer (accessed 23 January 2023).
  2. Sartore-Bianchi A, et al. ESMO Open. 2020;5:e000911.
  3. Yuan Y, et al. J Clin Oncol. 2021;39(Suppl.):e15554.
  4. Meric-Bernstam, et al. Ann Oncol. 2019;30(Suppl. 5):v159–93.
Question 4/5
In the phase II HERACLES trial, what was the ORR for patients with HER2-positive metastatic CRC who were treated with trastuzumab plus lapatinib?

CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2; ORR, overall response rate.
 Correct

In the phase II HERACLES trial, an ORR of 30% was reported in 27 patients with HER2-positive metastatic CRC treated with trastuzumab (intravenously at a 4 mg/kg loading dose, then at 2 mg/kg once per week) and lapatinib (orally at 1000 mg per day in 21-day treatment cycles), i.e. 1 weekly trastuzumab dose and 1 daily lapatinib dose.

Abbreviations

CRC, colorectal cancer; HER2, human epidermal growth factor receptor 2; ORR, overall response rate.

Reference

Sartore-Bianchi A, et al. Lancet Oncol. 2016;17:738–46.

Question 5/5
Your patient with metastatic CRC has just started fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapy. You think that your patient may be under-reporting the adverse effects associated with the treatment they are receiving. What course of action do you recommend next in the multidisciplinary care of this patient?

CRC, colorectal cancer.
 Correct

The reasons for some patients not reporting side effects may relate to a lack of awareness or education. Therefore, patients and their families must be aware of what side effects to expect and how to manage them, including when to seek medical advice. Many patients and their families may regard side effects as inevitable and not be aware that adverse effects can be alleviated. Some patients believe that “good” patients do not complain, or they do not want to distract their doctor from administering treatment. Given the importance of timely and accurate reporting of side effects experienced following chemotherapy, it is critical that strategies are implemented to ensure patients know how to appropriately respond to serious side effects they may experience.

Reference

Olver I, et al. Support Care Cancer. 2018;26:3579–86.

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