Oncology Knowledge into Practice Podcast – Details, episodes & analysis

In today's episode, we welcome Dr. Sandip Patel, who is a Professor of Medical Oncology at the University of California, San Diego, to discuss the evolution of molecular profiling technology, focusing on how next-generation sequencing can help support patients with advanced thyroid cancer, but also how to integrate molecular profiling into clinical practice.

Learning Objective(s):

After completing this educational activity, learners will be able to discuss precision medicine and new technologies, including liquid biopsy

Funding Information:

This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in collaboration with an independent steering committee; Eli Lilly had no influence on the content of this educational activity.

Accreditation:

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the ACHL and Liberum IME. ACHL is accredited by the ACCME to provide continuing medical education for physicians.

The Academy for Continued Healthcare Learning (ACHL) designates this enduring material for up to 0.25 AMA PRA Category 1 Credits™. Physicians should claim credit commensurate with the extent of their participation in the activity.

The American Medical Association (AMA) has an agreement of mutual recognition of Continuing Medical Education (CME) credits with the European Union of Medical Specialists (UEMS), the accreditation body for European countries. Physicians interested in converting AMA PRA Category 1 Credit™ to UEMS-European Accreditation Council for Continuing Medical Education CME credits (ECMEC®s) should contact the UEMS at mutualrecognition@uems.eu

The content for this activity was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

Faculty disclosures

Dr. Sandip Patel:

Scientific advising (Ongoing): Amgen, AstraZeneca, BeiGene, Bristol-Myers Squibb, Certis, Eli Lilly, Jazz, Genentech, Illumina, Merck, Pfizer, Rakuten, and Tempus

Institutional research funding (Ongoing): Amgen, AstraZeneca/MedImmune, Bristol-Myers Squibb, Eli Lilly, Fate Therapeutics, Gilead, Iovance, Merck, Pfizer, Roche/Genentech, SQZ Biotechnologies"

Other disclosures

Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

In today's episode, we welcome Dr. Conor Steuer, which is Associate Professor at the Department of Hematology and Medical Oncology at Emory University School of Medicine in Atlanta, USA, to discuss adaptation of thyroid cancer guidelines to local care settings. We touch on strategies for guideline implementation and how to overcome potential barriers.

Target Audience:

Oncologists, pathologists and other HCPs involved in the diagnosis of RET and TRK cancers, with a focus on community practitioners.

Learning Objective(s):

After completing this educational activity, learners will be able to:

• Recall thyroid RET and TRK fusion-positive cancer diagnosis and relevant genomic testing guidelines, and identify ways to adapt the guidelines to local settings

• Review the organization of care and strategies for more efficient care delivery

Funding Information:

This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in collaboration with an independent steering committee; Eli Lilly had no influence on the content of this educational activity.

Accreditation:

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the ACHL and Liberum IME. ACHL is accredited by the ACCME to provide continuing medical education for physicians.

The Academy for Continued Healthcare Learning (ACHL) designates this enduring material for up to 0.25 AMA PRA Category 1 Credits™. Physicians should claim credit commensurate with the extent of their participation in the activity.

The American Medical Association (AMA) has an agreement of mutual recognition of Continuing Medical Education (CME) credits with the European Union of Medical Specialists (UEMS), the accreditation body for European countries. Physicians interested in converting AMA PRA Category 1 Credit™ to UEMS-European Accreditation Council for Continuing Medical Education CME credits (ECMEC®s) should contact the UEMS at mutualrecognition@uems.eu

The content for this activity was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

Faculty disclosures:

Conor Steuer

Advisory Board/Steering Committee (Ongoing): Daiichi

Advisory Board (Former): Caris, Merck, Mirati, Novocure, Sanofi/Regeneron

Other disclosures

Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

In today’s episode, we’re going to talk about how precision medicine fits into thyroid cancer treatment guidelines. To answer our questions on this topic, we welcome the expertise of Dr. Lori Wirth. Dr. Wirth is Medical Director of the Center for Head and Neck Cancers at the Massachusetts General Hospital, and an Associate Professor in Medicine at Harvard Medical School.

Funding statement:

This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Eli Lilly has had no influence on the content of this education.

References:  

1. Filetti S, Durante C, Hartl D, et al. Thyroid Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019; 30:1856-1883. 
2. National Comprehensive Cancer Network. Thyroid Carcinoma. (Version 3.2021-October 15, 2021). Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed January 16, 2022. 
3. Fleeman N, Houten R, Chaplin M, et al. A systematic review of lenvatinib and sorafenib for treating progressive, locally advanced or metastatic, differentiated thyroid cancer after treatment with radioactive iodine. BMC Cancer. 2019;19:1209. https://doi.org/10.1186/s12885-019-6369-7 
4. Naoum GE, Morkos M, Kim B, Arafat W. Novel targeted therapies and immunotherapy for advanced thyroid cancers. Mol Cancer. 2018;17:51.  
5. Pekova B, Sykorova V, Mastnikova K, et al. NTRK fusion genes in thyroid carcinomas: Clinicopathological characteristics and their impacts on prognosis. Cancers.2021;13:1932. https://www.mdpi.com/2072-6694/13/8/1932 
6. Pitoia F. Complete response to larotrectinib treatment in a patient with papillary thyroid cancer harboring an ETV6-NTRK3 gene fusion. Clin Case Rep. 2021;9:1905-1912. doi: 10.1002/ccr3.3900  
7. VITRAKVI, Prescribing information. Bayer HealthCare Pharmaceuticals Inc. Revised: March 2021. 
8. ROZLYTREK, Prescribing information. Genentech USA, Inc. Revised: November 2021. 
9. Hong DS, DuBois SG, Kummar S, et al. Larotrectinib in patients with TRK fusion-positive solid tumours: a pooled analysis of three phase 1/2 clinical trials. Lancet Oncol. 2020;21:531-540. 
10. Chu YH, Dias-Santagata D, Farahani AA, et al. Clinicopathologic and molecular characterization of NTRK-rearranged thyroid carcinoma (NRTC). Mod Pathol. 2020;33:2186-2197.  
11. Doebele RC, Drilon A, Paz-Ares L, et al. Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1–2 trials. Lancet Oncol. 2020;21:271-282.  
12. RETEVMA, Prescribing information. Lilly USA, LLC. Initial US approval: 2020. 
13. GAVRETO, Prescribing information. Genentech USA, Inc. and Blueprint Medicines Corporation. Revised: April 2021. 
14. Krajewska J, Kukulska A, Oczko-Wojciechowska M, Jarzab B. Recent advances in precision medicine for the treatment of medullary thyroid cancer. Expert Review of Precision Medicine and Drug Development. 2021;6(5): 307-315. https://doi.org/10.1080/23808993.2021.1964952  
15. European Medicines Agency. Retsevmo. December 11, 2020. Accessed January 18, 2022. https://www.ema.europa.eu/en/medicines/human/EPAR/retsevmo 
16. European Medicines Agency. Gavreto. September 17, 2021. Accessed January 18, 2022. https://www.ema.europa.eu/en/medicines/human/EPAR/gavreto 

Precision medicine is a promising field that’s opening doors to novel therapeutics for many patients. But how does it fit into thyroid cancer specifically? What treatments are available or in the pipeline, for which patient subgroup, and what are the potential benefits? We’ll start off our series by exploring these questions, and we’ve invited Dr Eric Sherman, medical oncologist and thyroid cancer expert at the Memorial Sloan Kettering Cancer Center in New York, to provide his insights.

Funding statement:

This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Eli Lilly has had no influence on the content of this education.

References:

American Cancer Society. Key Statistics for Thyroid Cancer. Updated January 12, 2021. Accessed November 23, 2021. American Cancer Society website. https://www.cancer.org/cancer/thyroid-cancer/about/key-statistics.html.

Araque KA, Gubbi S, Klubo-Gwiezdzinska J. Updates on the Management of Thyroid Cancer. Horm Metab Res. 2020;52(8):562-577. doi: 10.1055/a-1089-7870.

Cancer Connect. Therapies Show Initial Effectiveness in Subset of Papillary Thyroid Cancer. Cancer Connect website. Published July 18, 2018. Accessed December 14, 2021. https://news.cancerconnect.com/thyroid-cancer/therapies-show-initial-effectiveness-in-subset-of-papillary-thyroid-cancer?redir=1.

ClinicalTrials.gov website search results: pembrolizumab / Thyroid Cancer / Phase 2. Accessed December 14, 2021. https://clinicaltrials.gov/ct2/results?term=pembrolizumab&cond=Thyroid+Cancer&age_v=&gndr=&type=&rslt=&phase=1&Search=Apply

Dabrafenib With or Without Trametinib in Treating Patients With Recurrent Thyroid Cancer. ClinicalTrials.gov identifier: NCT01723202. Updated February 25, 2021. Accessed December 14, 2021.

Drilon A, Laetsch TW, Kummar S, et al. Efficacy of Larotrectinib in TRK Fusion-Positive Cancers in Adults and Children. N Engl J Med. 2018;378(8):731-739. doi: 10.1056/NEJMoa1714448.

Pekova B, Sykorova V, Mastnikova K, et al. NTRK Fusion Genes in Thyroid Carcinomas: Clinicopathological Characteristics and Their Impacts on Prognosis. Cancers. 2021;13(8):1932. doi: 10.3390/cancers13081932.

U.S. Food & Drug Administration. FDA approves selpercatinib for lung and thyroid cancers with RET gene mutations or fusions. FDA website. Updated May 11, 2020. Accessed November 23, 2021. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-selpercatinib-lung-and-thyroid-cancers-ret-gene-mutations-or-fusions.

U.S. Food & Drug Administration. FDA approves pembrolizumab for adults and children with TMB-H solid tumors. Updated June 17, 2020. Accessed December 14, 2021. https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-pembrolizumab-adults-and-children-tmb-h-solid-tumors#:~:text=The%20recommended%20pembrolizumab%20dosage%20regimen%20for%20TMB-H%20solid,pediatric%20patients.%20View%20full%20prescribing%20information%20for%20KEYTRUDA.

U.S. Food & Drug Administration. FDA approves larotrectinib for solid tumors with NTRK gene fusions. FDA website. Updated December 14, 2018. Accessed November 25, 2021. https://www.fda.gov/drugs/fda-approves-larotrectinib-solid-tumors-ntrk-gene-fusions.

Weaver CH. Precision Cancer Medicine Treatment of Thyroid Cancers. Cancer Connect website. Published October 24, 2020. Updated September 20, 2021. Accessed November 23, 2021. https://news.cancerconnect.com/thyroid-cancer/precision-cancer-medicine-treatment-of-thyroid-cancers.

In this episode we speak with Dr Navel Daver, Associate Professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, USA, to get his thoughts on the highlights of ASCO and EHA for patients with MDS and AML.

Funding Statement:

This series is supported by educational grants from Servier Pharmaceuticals LLC and Takeda, who have had no influence on the content or choice of faculty

At the ASCO and EHA conferences, there were many interesting posters and presentations in the field of haemato-oncology. To share their conference highlights, we’ve invited our ALL expert Dr Dieter Hoelzer, director of internal medicine at the University of Frankfurt in Germany, and our MDS and AML expert Dr Amer Zeidan, Associate Professor Of Internal Medicine at the Yale University School Of Medicine in the US.

Funding statement: 

This series is supported by educational grants from Servier Pharmaceuticals LLC and Takeda, who have had no influence on the content or choice of faculty

Adult guidelines for acute myeloid leukaemia recommend determining a patient’s fitness before treating with standard therapy, but what does this mean, what are the implications, and how does this work in practice for both adults and children? To answer our questions on this topic, we’ve invited the expertise of Dr Courtney DiNardo, Associate Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center.

References

• Heuser et al. Ann Oncol. 2020 Mar 17;S0923-7534(20)36079-8
• PDQ Adult Treatment Editorial Board. Adult Acute Myeloid Leukemia Treatment (PDQ®): Health Professional Version. 2020 Aug 11
• Krug U, et al. Lancet. 2010;376(9757):2000-8
• Sorror, et al. 2017 Dec 1;3(12):1675-1682
• PDQ Pediatric Treatment Editorial Board. Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Health Professional Version. 2020 Aug 20

This series is supported by educational grants from Servier Pharmaceuticals LLC and Takeda, who have had no influence on the content or choice of faculty

Despite available treatments, many patients with acute myeloid leukaemia, or AML, are in need of additional therapeutic options. Thankfully, there hundreds of clinical trials for new interventions that could rectify this, but which options can we start to consider, for which patients and when? To answer our questions on this topic, we’ve invited the expertise of Dr Navel Daver, Associate Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center in Houston, Texas.

References:

• Swords, et al. Blood. 2018;131(13):1415-1424
• Stahl, et al. Curr Oncol Rep. 2019;21(4):37
• Yee at al. Blood (2014) 124 (21): 116.
• Montesinos et al. Future Oncol. 2020 May;16(13):807-815.
• Ades, et al. ASCO 2020. Abstract 7506
• DeAngelo, et al. Blood (2017) 130 (Supplement 1): 894.
• Ravandi, et al. Lancet Haematol. 2019 Sep; 6(9): e480-e488
• Hofmann, et al. J Clin Med. 2019 Feb; 8(2): 200.

This series is supported by educational grants from Servier Pharmaceuticals LLC and Takeda, who have had no influence on the content or choice of faculty

Although most commonly a disease of the old, Acute Myeloid Leukaemia is also a significant burden for younger patients, but it can present in different ways and they should not be treated equal. So how should younger and older patients be classified and treated? To help answer some of our questions on this topic is Dr. Tapan Kadia, Associate Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center in Houston, Texas.

References

• Public Health England. NCIN. 2015: 2013548
• Tarlock, et al. Pediatr Clin North Am. 2015 Feb;62(1):75-93
• Vakiti and Mewawalla. StatPearls: StatPearls Publishing; 2020 Jan
• PDQ Pediatric Treatment Editorial Board. Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Health Professional Version. 2020 Aug 20
• Bolouri. et al. Nat Med. 2018 Jan; 24(1): 103–112
• Silva, et al. Leukemia. 2017 Jul;31(7):1640-1644
• Nagal, et al. Ann Hematol. 2017; 96(12): 1993–2003
• Creutzig, et al. Blood. 2012 Oct 18;120(16):3187-205
• Sekeres, et al. Blood Adv. 2020 Aug 11;4(15):3528-3549
• Heuser et al. Ann Oncol. 2020 Mar 17;S0923-7534(20)36079-8
• Joon Im. Blood Res. 2018 Mar; 53(1): 1–2

This series is supported by educational grants from Servier Pharmaceuticals LLC and Takeda, who have had no influence on the content or choice of faculty.

For patients with myelodysplastic syndrome, or MDS, their therapy options vary considerably depending on their prognosis and risk of developing AML. Today we discuss risk stratification systems and their rationale, and consider their utility in clinical practice. To answer our questions on this topic, we welcome Professor Detlaf Haase, medical director of the special diagnostic laboratories at the clinic for hematology & medical oncology in at the University Medical Center in Göttingen, Germany.

References

• Greenberg, et al. Blood. 2012 Sep 20; 120(12): 2454–2465
• Montalban-Bravo & Garcia-Manero. Am J Hematol. 2018 Jan;93(1):129-147

This series is supported by educational grants from Servier Pharmaceuticals LLC and Takeda, who have had no influence on the content or choice of faculty.