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Oncology Consultations Vol. 5, No. 2

Release Date: November 21, 2008
Expiration Date: November 21, 2009

Publication Overview

Authors

Case by:
Vincent Miller, MD
Katharine Price, MD; Ramaswamy Govindan, MD; Vincent Miller, MD

Overview and Purpose

Agents inhibiting angiogenesis or signaling through epidermal growth factor receptor (EGFR) have improved response and survival compared to standard regimens in patients with advanced non–small-cell lung cancer (NSCLC). Recent clinical studies have been undertaken to expand the therapeutic reach of antiangiogenic and anti-EGFR agents. The only currently approved antiangiogenic agent in NSCLC is an antibody to vascular endothelial growth factor (VEGF); however, patients with brain metastases have been excluded from receiving anti-VEGF antibodies due to concern over bleeding. Preliminary results from prospective studies suggest that patients with treated brain metastases might safely receive anti-VEGF antibodies as part of a therapeutic regimen. Inhibitors of EGFR tyrosine kinase (TK) activity have demonstrated the greatest efficacy in patients with EGFR gene mutations or amplification as well as in never-smokers and patients of East Asian ethnicity. Recent trials have been designed to test EGFR TK inhibitors (TKIs) as single-agent frontline therapy in patient cohorts enriched for characteristics associated with response to these agents. Finally, new EGFR inhibitors are being developed as treatment options for patients who progress on first-generation EGFR TKIs.

The purpose of this activity is to update physicians on recent developments in agents inhibiting angiogenesis and EGFR signaling in NSCLC.

Target Audience

This activity is intended for medical oncologists involved in the care of patients with lung cancer. No specific skills or knowledge other than a basic training in oncology are required for successful participation in this activity.

Learning Objectives

Upon completion of this educational activity, you should be able to:

  • Evaluate the safety of anti-VEGF antibodies in patients with brain metastases from NSCLC
  • Evaluate the feasibility of EGFR TKIs as frontline single-agent treatment of selected patient populations with advanced NSCLC
  • Discuss the mechanisms of development of acquired resistance to EGFR-targeted therapies and potential therapies to overcome such resistance in patients with NSCLC

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  1. Read the following information before entering the educational activity.
  2. Complete the Pretest.
  3. Study the educational activity.
  4. Complete the CME test.
  5. Answer the evaluation questions.
  6. After successful completion of the CME test and evaluation, you will receive your certificate of credit online.

CME credit will be granted for only 1 form of participation, either online or via the printed publication.

Read all of the conditions in the Activity Terms box below. You must accept the Activity Terms in order to continue:

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It is the policy of Physicians’ Education Resource to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Physicians’ Education Resource requires everyone who is in a position to control the content of an educational activity, including spouses/partners, to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Physicians’ Education Resource has implemented a mechanism to identify and resolve all conflicts of interest prior to the activity.

Vincent Miller, MD
Paid Consultant – Abbott Laboratories; Agennix, Inc.; Boehringer Ingelheim GmbH; Genentech, Inc./OSI Pharmaceuticals; Genmab; ImClone Systems Incorporated; sanofi-aventis U.S.
Honoraria – Abbot Laboratories; Agennix, Inc; Boehringer Ingelheim GmbH; Genentech, Inc./OSI Pharmaceuticals; Genmab; ImClone Systems Incorporated; sanofi-aventis U.S.

Ramaswamy Govindan, MD
Research Funding – Genentech, Inc.; Pfizer Inc.; sanofi-aventis U.S.
Speaker’s Bureau – Eli Lilly and Company; Genentech, Inc.; sanofi-aventis U.S.

Katharine Price, MD
No relevant relationships to disclose

PER Editorial Staff
No relevant relationships to disclose

This CME activity might include discussion of investigational and/or unlabeled uses of drugs. If the activity includes discussion of investigational and/or unlabeled uses of a drug, specific information is located on the title page. Please refer to the full prescribing information for each drug discussed in this online newsletter for FDA-approved dosing, indications, and warnings.

Commercial Support
An educational grant for this activity was provided by Genentech BioOncology.

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The views and opinions expressed in this activity are those of the authors and do not necessarily reflect the views of the sponsor, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this activity to ensure accuracy, the authors and Physicians’ Education Resource and its servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this activity, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

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©Copyright 2008 by Physicians’ Education Resource. No material may be reproduced in whole or in part, in any form, without written permission from the publisher.

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Editor, Oncology Consultations
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Educational Grants

An educational grant for this activity was provided by:


  1. Genentech BioOncology