Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care - Colorectal Cancer

September 21, 2017

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.

Target Audience

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.

Learning Objectives

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.
Additional information
Supporters: 

This activity is supported by educational grants from:

  • Astellas and Medivation, Inc., a Pfizer Company
  • AstraZeneca
  • Celgene Corporation
  • Gilead Sciences, Medical Affairs
  • Lilly
  • Novartis
  • Pharmacyclics LLC, an AbbVie Company and Janssen Biotech, Inc.
  • Taiho Oncology
  • Takeda Oncology

This activity is supported by independent educational grants from:

  • AbbVie
  • Boehringer Ingelheim Pharmaceuticals, Inc.

This educational activity is supported by a medical education grant from Exelixis, Inc.

Course summary
Available credit: 
  • 1.00 ACPE contact hours
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC contact hours
  • 1.00 CCM clock hours
  • 1.00 Participation
Course opens: 
08/07/2017
Course expires: 
11/17/2017
Event starts: 
09/21/2017 - 1:00pm
Event ends: 
09/21/2017 - 2:00pm
Cost:
$0.00

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.

The faculty listed below discloses the following relevant financial relationships:
Chloe Atreya, MD, PhD
Cancer Panels: Consulting Fees, Honoraria
Champions Oncology, Inc: Consulting Fees, Honoraria
Roche/Genentech: Consulting Fees, Honoraria

Alan Venook, MD
Bayer HealthCare.: Scientific Advisor
Bristol-Myers Squibb Company: Scientific Advisor
Genentech, Inc.: Grant/Research Support; Scientific Advisor
Merck & Co., Inc.: Grant Research Support; Scientific Advisor
Taiho Pharmaceuticals Co., Ltd.: Scientific Advisor

The NCCN Activity Planning staff listed below discloses no relevant financial relationships:
Kim Bayer; Mark Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Joan S. McClure, MS; Diane McPherson; Melanie Moletzsky; Lisa Perfidio; Liz Rieder; Shannon K. Ryan; Kathy Smith; Melinda Somasekhar, PhD

The NCCN Clinical Information staff listed below, who has reviewed content, discloses no relevant financial relationships:
Deborah Freedman-Cass, PhD

The ACCME/ANCC/ACPE defines “conflict of interest” as when an individual has an opportunity to affect CE content about products or services of a commercial interest with which he/she has a financial relationship.

ACCME, ACPE, and ANCC focuses on financial relationships with commercial interests in the 12-month period preceding the time that the individual is being asked to assume a role controlling content of the CE activity. ACCME, ACPE, and ANCC have not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship. The ACCME, ACPE, and ANCC defines “relevant’ financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.

All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation to the tasks and methods of delivery.

Faculty presentations may include discussion of off-label use.  Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling.

Physicians
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.

Physician Assistants
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.

Nurses
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.

Case Managers
This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. This course is approved for 1.0 CE contact hour. Activity Code: I00028519; Approval Number: 170003527

Pharmacists

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. UAN: 0836-0000-17-087-L01-P

Available Credit

  • 1.00 ACPE contact hours
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC contact hours
  • 1.00 CCM clock hours
  • 1.00 Participation

Accreditation Period

Course opens: 
08/07/2017
Course expires: 
11/17/2017

Price

Cost:
$0.00
Please login or register to take this course.

Required Hardware/software

To complete this activity, users will need:

  • A device with an Internet connection and sound playback capability
    • One of the two latest versions of Google Chrome, Mozilla Firefox, or Safari
    • Internet Explorer is no longer supported
  • Adobe Reader or other PDF reader software for certificate viewing/printing