Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care - Colorectal Cancer
Join Chloe Atreya, MD, PhD, and Alan Venook, MD, from the UCSF Helen Diller Family Comprehensive Cancer Center as they present their multidisciplinary expertise on a range of cases pertaining to colorectal cancer.
The management of metastatic colorectal cancer (mCRC) has, for many years, involved a continuum of care in which patients are exposed sequentially to a wide variety of chemotherapeutic and targeted agents. Clinicians have considered many factors when choosing therapies and sequence of therapies for each patient, including the goals of treatment, the type and timing of prior therapy, the different efficacy and toxicity profiles of the regimens, the KRAS, NRAS, and BRAF mutational status of the tumor, and patient comorbidities and preferences. In the 2017 versions of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colon Cancer and the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Rectal Cancer, several changes add to the factors that must be considered for optimal therapy selection. First, EGFR inhibitor use in first-line therapy is now limited to patients with primary tumors originating in the rectum or the left side of the colon (splenic flexure to rectum). This restriction is based on a growing body of data showing that cetuximab and panitumumab appear to confer little if any benefit to patients with mCRC if the primary tumor originated on the right side of the colon. In particular, the phase III CALGB/SWOG 80405 trial showed that patients with all RAS wild-type, right-sided primary tumors (cecum to hepatic flexure) had shorter overall survival with cetuximab than with bevacizumab (13.6 months vs 29.2 months), whereas patients with all RAS wild-type, left-sided primary tumors had longer overall survival with cetuximab than with bevacizumab (39.3 months vs 32.6 months). Second, PD-1 checkpoint inhibitors nivolumab and pembrolizumab both extended progression-free survival in patients with MMR-deficient mCRC in phase 2 studies. These two drugs have been added to the continuum of care for mCRC, bringing immunotherapies into the list of treatment options and making tumor mismatch repair (MMR) status another factor that impacts treatment decisions for patients with mCRC.
Thus, the continuum of care for patients with mCRC now includes 20 first-line treatment options, 33 second-line options, and 13 options for subsequent therapies; patients can receive up to seven lines of therapy. The location of the primary tumor and the MMR status of the tumor are new factors that must be considered when making treatment decisions.
This educational program is designed to meet the educational needs of oncologists, pathologists, nurses, pharmacists, case managers, and other health care professionals who manage patients with cancer.
Chloe Atreya, MD, PhD
UCSF Helen Diller Family Comprehensive Cancer Center
Alan Venook, MD
UCSF Helen Diller Family Comprehensive Cancer Center
Disclosure of Relevant Financial Relationships
All faculty and activity planners participating in NCCN continuing education activities are expected to disclose any relevant financial relationships with a commercial interest as defined by the ACCME’s, ANCC’s, and ACPE’s Standards for Commercial Support. All faculty presentations have been reviewed for adherence to the ACCME’s Criterion 7: The provider develops activities/educational interventions independent of commercial interests (SCS 1, 2, and 6) by experts on the topics. Full disclosure of faculty relationships will be made prior to the activity.
National Comprehensive Cancer Network (NCCN) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
NCCN designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 1.0 hour of Category I credit for completing this activity.
National Comprehensive Cancer Network (NCCN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
NCCN designates this educational activity for a maximum of 1.0 contact hour.
This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. Credit approval for case managers is pending for this program. If approved, Activity Code and Approval Number will be posted prior to activity date.
|National Comprehensive Cancer Network (NCCN) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.|
NCCN designates this knowledge-based continuing education activity for 1.0 contact hour (0.1 CEUs) of continuing education credit. Universal Activity Number (UAN) will be posted prior to activity date.
- 1.00 CCM clock hours
- 1.00 ACPE contact hours
- 1.00 ANCC contact hours
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation
Following this activity, participants should be able to:
- Describe recent changes to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colon Cancer and the NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines® Rectal Cancer.
- Discuss the data supporting the use of PD-1 checkpoint inhibitors nivolumab and pembrolizumab in patients with mismatch repair-deficient mCRC tumors.
- Explain the role of primary tumor location in treatment decisions for mCRC.
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