Program Description

Non-small cell lung cancer (NSCLC) can no longer be considered a homogenous disease. Histologic and molecular features of NSCLC provide important prognostic information and predict response to targeted therapy; therefore, therapy must be individualized according to these criteria to maximize patient outcomes. Maintenance therapy is being increasingly used in NSCLC instead of the traditional approach of first-line therapy, then waiting for disease progression. The staging system for NSCLC has been revised with respect to disease reclassification, likely impacting treatment approaches. The rapidly evolving treatment paradigm for NSCLC has generated practice gaps surrounding the best approaches to improve patient outcomes.

This series of interactive case activities is designed to increase awareness of histologic and molecular features of prognostic and predictive significance in advanced NSCLC in order to optimize systemic therapy choices in the frontline and maintenance settings and beyond. Participants will be presented with patient case scenarios and management choices. The appropriateness of these management choices will be discussed in the context of the currently available clinical evidence.

Faculty

Corey J. Langer, MD, FACP Director of Thoracic Oncology Abramson Cancer Center Professor of Medicine Hematology-Oncology Division University of Pennsylvania Philadelphia, PA Read Biography Corey J. Langer, MD, FACP is board-certified in internal medicine and hematology/oncology. He is a Professor of Medicine in the Hematology/Oncology Division at the University of Pennsylvania in Philadelphia, PA, where he serves as Director of Thoracic Oncology in the Abramson Cancer Center and co-leads its Translational Therapeutics Program. Dr. Langer received his medical degree from Boston University in Boston, MA in 1981 and completed his internship and residency in medicine at the Graduate Hospital of the University of Pennsylvania. Additional postgraduate training included a fellowship in hematology/oncology at the Penn Presbyterian Medical Center and a fellowship in oncology at AOH/Fox Chase Cancer Center (FCCC). Dr. Langer served in the oncology division of FCCC for 22 years from 1986 until 2008, and for the last 14 years of his tenure there, he led its Thoracic Oncology Program. He also served as the Research Chair of Oncology Physicians Network, a consortium of academic and community facilities in the Delaware Valley allied with FCCC. In June of 2008, he moved to the University of Pennsylvania where he currently leads the Thoracic Oncology Program. Dr. Langer is a fellow of the American College of Physicians and is a member of the American Society of Clinical Oncology (ASCO), the American Association for Cancer Research (AACR), the International Association for the Study of Lung Cancer (IASLC), and the Society of Head and Neck Surgeons. He serves as vice-chair of the Radiation Therapy Oncology Group (RTOG) and chairs its Medical Oncology Subcommittee. He also serves on the core Thoracic and Head and Neck Committees of both the Eastern Cooperative Oncology Group (ECOG) and RTOG. He is chair of the Commission on Cancer, Head and Neck Cancer Database Committee, under the aegis of the American College of Surgeons. Also, Dr. Langer has contributed numerous articles (>140) and abstracts to medical literature. His work on head and neck squamous cell cancer and non-small cell lung cancer has appeared in the New England Journal of Medicine (NEJM), Seminars in Oncology, Clinical Cancer Research, Journal of Clinical Oncology, Journal of Thoracic Oncology, Clinical Lung Cancer, Cancer, Lung Cancer, Cancer Investigation, and EJC. His work has also been presented at the national meetings of ASCO, AACR, ASH, and the IASLC. He has served three separate terms as a member of the editorial board of the Journal of Clinical Oncology, and is currently on the editorial boards of Clinical Lung Cancer and Clinical Advances in Hematology and Oncology. He is also a frequent lecturer at numerous medical symposia and grand rounds.

Mark A. Socinski, MD Professor of Medicine Multidisciplinary Thoracic Oncology Program Lineberger Comprehensive Cancer Center University of North Carolina Chapel Hill, NC Read Biography Mark A. Socinski, MD is Professor of Medicine and co-leader of the Multidisciplinary Thoracic Oncology Program at the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. A national expert on lung cancer, he serves as co-chair of the National Cancer Institutea[euro](TM)s Thoracic Malignancy Steering Committee and is an active member of the Respiratory Committee of the Cancer and Leukemia Group B. Dr. Socinski has led national and international trials of new therapies, most recently an international clinical trial evaluating BLP25 liposome vaccine. His clinical research findings have been published in numerous journals, including the Journal of Clinical Oncology and the Journal of Thoracic Oncology. He earned his undergraduate degree in zoology from the University of Vermont, followed by both his medical degree and a master's degree in pathology from the University of Vermont in Burlington, VT. He completed his residency in internal medicine at Harvard Medical Schoola[euro](TM)s Beth Israel Hospital and a fellowship in medical oncology at the Dana-Farber Cancer Institute in Boston, MA.

University of Michigan Content Reviewer

Samuel M. Silver, MD, PhD
Professor, Division of Hematology/Oncology
Director, University of Michigan Cancer Center
Ann Arbor, MI

Target Audience

These activities were designed to meet the educational needs of medical oncologists, surgical oncologists, and radiation oncologists involved in the management of patients with NSCLC.

Educational Objectives

These activities were designed to address the following IOM competencies: provide patient-centered care; work in interdisciplinary teams; employ evidence-based practice

Case 1 – 50-year-old female nonsmoker with mild cough and dyspnea on exertion

At the conclusion of this activity, participants should be able to:

• Identify biomarkers useful in the workup of treatment-naive patients with advanced NSCLC
• Select individualized frontline therapy for advanced NSCLC based on tumor histology and molecular features, as well as patient characteristics
• Indicate the approach to manage toxicities associated with EGFR targeted therapies

Case 2 – 65-year-old male former smoker with hip pain, fatigue, mild dyspnea, and hemoptysis

At the conclusion of this activity, participants should be able to:

• Select individualized frontline therapy for advanced NSCLC based on tumor histology and molecular features, as well as patient characteristics
• Identify appropriate continuation or switch maintenance therapy approaches for patients responding to frontline therapy

Case 3 – 55-year-old Caucasian male presents with dyspnea on exertion and hemoptysis

At the conclusion of this activity, participants should be able to:

• Recognize salient changes in the M classification of non-small cell lung cancer (NSCLC) incorporated into the updated AJCC staging system
• Indicate the clinical outcomes of patients with advanced squamous cell NSCLC in pivotal clinical trials
• Select optimal treatment sequence (frontline, maintenance, and beyond) for patients with advanced squamous NSCLC

Case 4 – 47-year-old Caucasian female remote prior smoker presents with dyspnea on exertion and rib pain

At the conclusion of this activity, participants should be able to:

• Indicate the clinical outcomes of patients with advanced non-squamous cell non-small cell lung cancer (NSCLC) in pivotal clinical trials
• Select optimal treatment sequence (frontline, maintenance and beyond) for patients with advanced non-squamous NSCLC

Accreditation And Designation Statements

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Michigan Medical School designates each educational activity for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should only claim online credit commensurate with the extent of their participation in the activity.

Instructions for Participation and Credit
This activity is a self-study program: Completion of this activity involves successfully completing the case study and accompanying questions and completing the evaluation online at the end of the program, which may take up to 15 minutes.

There is no fee for this program.

Disclosure Policy

University of Michigan Medical School (UMMS) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by UMMS for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests.

Mark A. Socinski, MD: Speaker's Bureau: Genentech, Eli Lilly; Grant/Research Support: Genentech, Eli Lilly, Pfizer, Abraxis, Celgene

Corey J. Langer, MD, FACP: Speaker's Bureau: Eli Lilly, Genentech, OSI, Bristol-Myers Squibb, ImClone; Grant/Research Support: Bristol-Myers Squibb, Pfizer, Eli Lilly, ImClone, Genentech, OSI; Scientific Advisor: Bristol-Myers Squibb, Eli Lilly, ImClone, Sanofi-Aventis, Pfizer, Amgen, AstraZeneca, Novartis, Genentech, Bayer/Onyx, Abraxis, Abbott, Morphotek, Biodesix, Clarient, Caris Dx

Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

UMMS – Samuel M. Silver, MD, PhD; Rockpointe – Paul Walden, PhD; Betsy Dennison, MS, RN, FNP; Jay Katz; Blair St. Amand: Nothing to disclose

FDA Disclosure

The contents of some CME/CE activities may contain discussions of non-approved or off-label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.

System Requirements

Flash Player 7 or later recommended), and one of the following browsers:

• Windows: Internet Explorer 6 and later, Firefox 1.x and later, Safari 3 and later, Google Chrome, Opera 9.5 and later
• Macintosh: Safari 3 and later, Firefox 1.x and later, Google Chrome
• Linux: Firefox 1.x and later

Sponsored by the

Educational partner:

These activities are supported by educational grants from Genentech BioOncology, OSI Oncology, and Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

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