Using Biomarkers to Guide Diagnosis and Treatment for NSCLC: An In-Depth Look at EGFR and ALK

Published Online: December 20, 2013
This activity is supported by educational grants from Astellas and Lilly USA, LLC.

Faculty
Yujie Zhao, MD, PhD Assistant Professor of Oncology Roswell Park Cancer Institute Buffalo, NY

Contributing Editor
Alex A. Adjei, MD, PhD, FACP Senior Vice-President, Clinical Research Professor and Chairman, Department of Medicine Katherine Anne Gioia Chair in Cancer Medicine Roswell Park Cancer Institute Buffalo, NY
Activity Overview
This activity is intended to provide an understanding of the optimal use and interpretation of biomarker testing in patients with non-small cell lung cancer. The discussion is designed to raise the level of knowledge and competency about the role biomarkers play in diagnosis and treatment of patients with non-small cell lung cancer (NSCLC), especially those patients with EGFR mutations or ALK rearrangements. The science shows that targeted therapies can be very effective for these patients, yet clinical practice has not completely caught up to the research. The goal of this activity is to help close this gap, thereby improving patient outcomes.

Overall Educational Objectives
Upon completion of the educational activity, the participants should be able to:
  1. Demonstrate knowledge of the current guidelines for biomarker testing in NSCLC
  2. Select patients for EGFR-targeted treatment based on appropriate EGFR biomarker testing
  3. Identify patients who should receive ALK-targeted therapy based on biomarker testing results
  4. Develop and implement a reflex biomarker testing protocol for patients with NSCLC in the clinic
  5. Analyze recent clinical trial data on novel treatments and emerging therapies for management of NSCLC
Intended Audience: Oncologists, pulmonologists, pathologists, interventional radiologists, and oncology nurses who are involved in treating patients with NSCLC.
Release Date: December 9, 2013
Expiration Date: December 9, 2014
Estimated time to complete activity: 1 hour
Medium: Print with Internet-based posttest, evaluation, and request for credit.

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Cincinnati and ArcMesa Educators, LLC. The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The University of Cincinnati designates this Enduring Material Activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Obtaining Credit:
Participants must read the article, complete the posttest achieving a passing score of 70% or higher, and complete an evaluation and request for credit. Detailed instructions on obtaining CME credit are included at the end of this activity.

Disclosure Policy
According to the disclosure policy of the University of Cincinnati, all persons who are in a position to control content are required to disclose any relevant financial relationships with commercial interests. If a conflict is identified, it is the responsibility of the University of Cincinnati to initiate a mechanism to resolve the conflict(s). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

Disclosure of Unapproved/Off-Label Use
The contents of this activity may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.

Disclosures
Yujie Zhao, MD, PhD, has no relevant financial relationships with commercial interests to disclose.

Alex A. Adjei, MD, PhD, FACP, has no relevant financial relationships with commercial interests to disclose.

International Journal of Targeted Therapies in Cancer
Planning Staff—Sandra Kear has no relevant financial relationships with commercial interests to disclose.

ArcMesa Educators, LLC
Planning Staff—Judy V. Lum, MPA; Maryjo Dixon, RPh; and Susannah Orenstein have no relevant financial relationships with commercial interests to disclose.

University of Cincinnati
Planning Staff—Susan P. Tyler, MEd, CMP, CCMEP, has no relevant financial relationships with commercial interests to disclose.

CME Physician Reviewer – Rick Ricer, MD, has no relevant financial relationships with commercial interests to disclose.

Using Biomarkers to Guide Diagnosis and Treatment for Non-Small Cell Lung Cancer: An In-Depth Look at EGFR and ALK
Yujie Zhao, MD, PhD
Roswell Park Cancer Institute, Buffalo, NY

Introduction
Lung cancer is the leading cause of cancer-related mortality in the United States. The estimated number of new cases of lung cancer in the United States in 2013 is 228,190; the estimated number of deaths is 159,480.1 Lung cancer is expected to account for 26.4% of all female cancer deaths and 28.4% of all male cancer deaths in 2013. Tobacco use remains the most important environmental factor associated with the development of lung cancer, with more than a 10-fold increase in risk of lung cancer development in smokers. Due to the decrease in smoking prevalence, lung cancer incidence rates in women began declining in the late 1990s, more than a decade after the decline began in men, reflecting historical differences in tobacco use.1

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