NSCLC EGFR-Targeted Therapies: The Oncology Pharmacist's Role in Tailoring Therapy and Improving Patient Outcomes

Activity Details
  • Credit Amounts:
    • CPE: 1.25
    • Other: 1.25
  • Cost: Free
  • Release: Jun 19, 2017
  • Expires: Jun 19, 2018
  • Estimated Time to Complete:
    1 Hour(s)  15 Minutes
  • System Requirements:
  • Average User Rating:
    (2 Ratings)
This activity was recorded on March 29, 2017 during the HOPA Annual Meeting.

On September 28, 2017, the National Comprehensive Cancer Network updated its NSCLC Clinical Practice Guidelines to include the use of osimertinib as a 1st-line treatment option for patients with locally-advanced or metastatic EGFR mutation-positive NSCLC. Subsequently, on October 9, 2017, the FDA granted Breakthrough Therapy Designation for osimertinib in the 1st-line treatment of patients with EGFR-positive NSCLC. 

Faculty

Val R.  Adams Val R. Adams, PharmD, FCCP, BCOP
(Activity Chair)
Associate Professor of Pharmacy Practice and Science
Program Director
PGY2 Oncology Pharmacy Residency
University of Kentucky
College of Pharmacy
Lexington, KY


Josiah D.  Land Josiah D. Land, PharmD, BCOP
Clinical Pharmacy Specialist
Thoracic Medical Oncology Team
Memorial Sloan Kettering Cancer Center
New York, NY

Philip Schwieterman Philip Schwieterman, PharmD, MHA
Pharmacy Director, Oncology and Infusion Pharmacy
UK HealthCare and Markey Cancer Center
Lexington, KY

Needs Statement

Lung cancer is the most common cancer worldwide, as well as the leading cause of cancer death.1 Non small-cell lung cancer (NSCLC) accounts for more than 85% of lung cancer cases, and is typically associated with a poor prognosis (5-year survival rate of 17.7% at diagnosis.)2,3 Historically, advanced NSCLC has had a “one-size-fits-all” treatment paradigm, with platinum-based chemotherapy being the first-line choice. The discovery of NSCLC epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations have led to the development of biomarker specific targeted therapies and the individualization of NSCLC treatment.4,5 The use of targeted therapies such as oral EGFR tyrosine kinase inhibitors (TKIs), have dramatically changed the NSCLC treatment landscape by impacting disease control, symptom palliation, and both progression-free and overall survival rates in selected patients.6 However, despite initial improvement in survival outcomes, almost all patients taking first-line EGFR TKIs eventually develop resistance to TKI therapy. The T790M mutation is a common mechanism of acquired resistance to EGFR TKIs. Increased understanding of resistance mechanisms have resulted in the development of third generation TKIs which irreversibly inhibit mutant EGFR, particularly T709M.7,8 The emergence of targeted therapies for NSCLC and advances in understanding tumor resistance mechanisms highlight the need for genotype-guided therapy and underline the importance of appropriate molecular testing to personalize lung cancer treatment.

The availability of oral chemotherapy agents such as the TKIs, has significantly changed the landscape of traditional chemotherapy management for both patients and healthcare providers.  Oncology pharmacists are optimally positioned to help ensure safe ordering, dispensing, and administration of oral chemotherapy and to optimize treatment by tailoring NSCLC therapies based on molecular testing to improve patient outcomes and provide cost-effective care.9

The objective of this educational activity is to provide evidence-based information on the latest developments in NSCLC, including updates on EGFR TKIs and the importance of EGFR mutation testing to individualize NSCLC treatment.  Expert faculty will examine the current role and future opportunities for oncology pharmacists to optimize the use of targeted therapies by developing strategies to minimize drug toxicities and financial burden. Cases will be used to examine contemporary challenges in managing EGFR NSCLC and highlight opportunities for oncology pharmacists to improve patient care.

1Ferlay J, et al. Int J Cancer. 2015, 2George J, et al. Nature. 2015, 3https://seer.cancer.gov/statfacts/html/lungb.html, 4Tan DS, et al. J Thorac Oncol. 2016, 5Sorber L, et al. Lung Cancer. 2016, 6Berge EM, et al. Semin Oncol. 2014, 7Hata A, et al. Cancer. 2013, 8Sequist LV, et al. N Engl J Med. 2015, 9http://www.hoparx.org/advocacy/health-policy-agenda.

Target Audience

This activity is designed to meet the educational needs of oncology pharmacists.

Objectives

At the conclusion of this application-based activity, participants will be able to:

1. Review the pathology of advanced NSCLC and examine clinically relevant molecular mutations that impact treatment strategies.

2. Assess the targeted treatment options for advanced EGFR-mutated NSCLC, during therapy initiation and in the setting of acquired resistance, focusing on safety, efficacy, and the individualization of therapy based on tumor and patient specific factors.

3. Examine current recommendations for molecular testing and the clinical utility of ctDNA liquid biopsy in guiding therapy, especially as it relates to EGFR T790M mutations.

4. Explore the role of the oncology pharmacist in optimizing the use of targeted therapies for NSCLC and opportunities to advance oncology pharmacy services.

5. Using a case-based approach, explore challenging questions regarding EGFR targeted therapy and discuss ways the oncology pharmacist can optimize therapy, manage toxicities, and play a role in improving adherence strategies.

Accreditation

CPE

In support of improving patient care, Creative Educational Concepts is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This -based activity is approved for 1.25 contact hours (0.125 CEUs) of continuing pharmacy education credit (UAN 0245-0000-17-006-H01-P).

Other
Creative Educational Concepts, Inc. certifies this activity for 1.25 hours of participation.

Faculty Disclosure

Planner and Faculty Disclosures

In accordance with the Food and Drug Administration, the speakers have disclosed that there is the potential for discussions concerning off-label uses of a commercial product/device during this educational activity.

Any person who may contribute to the content of this continuing education activity must disclose relevant relationships (and any known relationships of their spouse/partner) with commercial interests whose products or services are discussed in educational presentations. A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Relevant relationships include receiving from a commercial interest research grants, consultant fees, travel, other benefits, or having a self-managed equity interest in a company.

Disclosure of a relationship is not intended to suggest or condone any bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Planner: 
Adrienne Matson, PharmD, BCPS - has no relevant financial relationships to disclose in relation to the content of this activity.

Authors/Presenters:
Val R. Adams, PharmD, FCCP, BCOP - has no relevant financial relationships to disclose in relation to the content of this activity.

Josiah D. Land, PharmD, BCOP – has no relevant financial relationships to disclose in relation to the content of this activity.

Philip Schwieterman, PharmD, MHA - has no relevant financial relationships to disclose in relation to the content of this activity.

 

Activity Instructions

Media: Internet Web Activity (Powerpoint slides and audio)

Instructions:

To receive a statement of credit, you must:

  • Read the target audience, learning objectives, and author disclosures.
  • Review the full content of the activity and reflect upon its teaching.
  • Complete the questions and evaluation at the end of the activity.
  • You must have a passing score of 70% on the post-test. You will have two (2) opportunities to complete the post-test.