Hyatt Regency Orlando
9801 International Drive
Orlando, FL 32819
Hotel Phone: (407) 284-1234

Meeting Room:
Florida Ballroom (C Level)

Time:
6:15 AM – 7:45 AM

Breakfast buffet will be available for those attending the event.

An older man who initially received treatment for Stage II colon cancer (CC) experiences relapse and receives multiple lines of systemic therapy
CASE 1: A 72-year-old man underwent surgical resection for Stage II CC with no adjuvant systemic therapy. One year later he developed abdominal pain, and CT scan showed a 3-cm mesenteric mass, which was biopsied and confirmed to be KRAS-mutated metastatic CC. He received FOLFOX/bevacizumab but experienced disease progression after 6 cycles and was switched to FOLFIRI/bevacizumab. He initially responded but was found to have progression after 18 cycles, at which time regorafenib was initiated at 120 mg PO daily for 21 of 28 days. Within 10 days he developed significant side effects, and regorafenib was held for 1 week and restarted at the same dose with improvement in side effects and symptoms. Imaging showed a decrease in the mesenteric mass, and the patient fared well. After 6 cycles he experienced disease progression and was started on TAS-102 on a clinical trial. He has struggled with alcohol abuse throughout his treatment course. (Ms Mitchell)

DISCUSSION TOPICS:

• Expanded RAS testing and difference between RAS-mutant and wild-type colorectal cancer (CRC)
• Selection of first-line and second-line chemotherapy and biologic therapy for patients with RAS-mutated metastatic CRC (mCRC)
• Indications for the use of regorafenib in advanced CRC
• Considerations for initial dosing of regorafenib: Importance of careful follow-up in the first month of treatment
• Spectrum of toxicity associated with regorafenib, and approach to management
• Mechanism of action of, available research data with and potential role of TAS-102

A 58-year-old man with preexisting diabetes who receives multiple lines of systemic therapy
CASE 2: A 58-year-old man with diabetes initially received adjuvant FOLFOX in 2008 for Stage IIIB colon cancer, with discontinuation of oxaliplatin after 9 cycles due to neuropathy. Three years later he experienced disease recurrence, was enrolled on CALGB-80405 and received FOLFIRI/bevacizumab. He voluntarily came off the study and continued treatment but elected to take a break after 6 months. In April 2013 FOLFIRI/bevacizumab was resumed followed by maintenance 5-FU/bevacizumab. His disease progressed and he received irinotecan/panitumumab for 1 year, during which he experienced significant treatment related side effects, including rash, conjunctivitis and paronychia and exacerbated diabetes. At the patient’s request, treatment was discontinued, at which time he became more disciplined in the management of his diabetes. CAPOX was initiated in January 2015 for disease progression. (Ms Triglianos)

DISCUSSION TOPICS:

• Role of EGFR antibodies for patients with mCRC
• Prophylaxis and management of dermatologic toxicities (eg, rash, hand-foot syndrome) associated with commonly employed systemic therapies for mCRC
• Treatment holidays for patients receiving long-term systemic therapy for mCRC
• Effective methods to assess and foster adherence with oral anticancer medications (eg, capecitabine, regorafenib) in noncompliant patients
• Selection of systemic therapeutic options for patients with disease progression after multiple lines of therapy

A young man with end-stage mCRC who has 2 minor children
CASE 3: A 36-year-old man with sons aged 3 and 6 underwent resection for Stage III CRC and received adjuvant FOLFOX, which was poorly tolerated and ultimately resulted in a severe anaphylactic allergic reaction to oxaliplatin. Treatment was continued with 5-FU/leucovorin. Eight months after completion of adjuvant therapy he developed ureteral obstruction from a retroperitoneal lymph node, which on biopsy was proven to be a recurrence. He received FOLFIRI/bevacizumab and a right nephroureterectomy followed by postoperative radiation therapy and capecitabine. He experienced significant treatment-related side effects, including hospitalization for acute renal insufficiency. One month after completing radiation therapy he developed a small bowel obstruction and was found to have peritoneal and liver metastases during diagnostic laparotomy. The patient declined further treatment and was referred for hospice care. (Ms Mitchell)

DISCUSSION TOPICS:

• Indications for adjuvant therapy
• Preparedness for and management of infusion and hypersensitivity reactions
• Management of local complications of cancer
• Integrating palliative care into the treatment of mCRC
• Counseling patients and their families regarding end-of-life issues, and providing age-appropriate counseling and support for minor children

An older woman with mCRC with disease progression after 2 courses of systemic treatment
CASE 4: An 80-year-old woman presented with synchronous primary and metastatic RAS-mutant CRC and underwent resection of the primary tumor due to obstruction. She initially received FOLFOX/bevacizumab with discontinuation of oxaliplatin due to neuropathy. She experienced disease progression and was switched to FOLFIRI/bevacizumab. She was not able to tolerate treatment, experiencing significant fatigue, diarrhea and anorexia, and was ultimately confined to a wheelchair. Dose adjustments were made with no improvement in side effects. This treatment was discontinued, and late-line treatment was discussed with the patient. (Ms Triglianos)

DISCUSSION TOPICS:

• Role of up-front systemic therapy for patients presenting with a primary tumor and simultaneous metastatic disease
• Potential curability of mCRC: Surgical resection of isolated metastases
• Management of mCRC in older patients; role of dose reductions and delays
• Communicating expected risks and side effects of various chemotherapeutic and biologic approaches, and developing effective patient care plans
• Incidence, management and long-term resolution of oxaliplatin-related neuropathy
• Counseling patients regarding the discontinuation of active therapy

Target Audience
This activity has been designed to meet the educational needs of oncology nurses, nurse practitioners and clinical nurse specialists involved in the treatment of CRC.

Learning Objectives

• Apply existing and emerging research data to the therapeutic and supportive care of patients with mCRC.
• Describe the clinical impact of and toxicities associated with commonly used systemic therapies for mCRC.
• Develop an evidence-based algorithm for the prevention and amelioration of side effects associated with chemotherapeutic and biologic agents used in the management of mCRC.
• Use case-based learning to facilitate improved counseling for patients.
• Identify opportunities to enhance the collaborative role of oncology nurses in the comprehensive biopsychosocial care of patients with mCRC to improve clinical and quality-of-life outcomes.

Accreditation Statements
This educational activity for 1.5 contact hours is provided by Research To Practice.

Research To Practice is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

To obtain a certificate of completion and receive credit for this event, attendees must sign in at the registration desk upon arrival, attend the entire activity and return a completed Educational Assessment and Credit Form upon exiting the activity. Your certificate will be mailed to you within 4 to 6 weeks. International clinicians, please note: In order for a certificate of completion to be issued, you must provide a valid email address.

Unlabeled/Unapproved Uses Notice
There is no implied or real endorsement of any product by Research To Practice or the American Nurses Credentialing Center. Any off-label use as declared by the FDA will be identified.

Content Validation and Disclosures
Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CNE activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — Ms Mitchell and Ms Triglianos have no real or apparent conflicts of interest to disclose. The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process: Dr Bekaii-Saab — Consulting Agreements: Amgen Inc, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Lilly, Pfizer Inc, Taiho Pharmaceutical Co Ltd; Contracted Research: Oncolytics Biotech Inc; Other Remunerated Activities: Exelixis Inc, Polaris Group. Dr Grothey — Contracted Research: Bayer HealthCare Pharmaceuticals, Eisai Inc, Genentech BioOncology, Lilly, Pfizer Inc, Sanofi.

MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Amgen Inc, Astellas Scientific and Medical Affairs Inc, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Myriad Genetic Laboratories Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Teva Oncology, Tokai Pharmaceuticals Inc and VisionGate Inc.

Research To Practice staff and external reviewers — The scientific staff, planners, managers and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This activity is supported by an educational grant from Bayer HealthCare Pharmaceuticals.

Hyatt Regency Orlando
9801 International Drive
Orlando, FL 32819
Hotel Phone: (407) 284-1234

Meeting Room:
Florida Ballroom (C Level)

Directions:
The Hyatt Regency Orlando hotel is conveniently located within walking distance (5 to 10 minutes) of the Orange County Convention Center and is the host hotel for the ONS 40^th Annual Congress.

» View directions

Thank you for your interest in our CNE program. At this time preregistration is closed for this event as we have reached seating capacity. Onsite standby registration will be open starting at 5:15 AM on Friday, April 24. If you are interested in standby registration, please visit our onsite registration desk located outside the Florida Ballroom (C Level) at the Hyatt Regency Orlando, Orlando, Florida (9801 International Drive).

If seats become available for the program, we will accept standby registrations on a first come, first served basis prioritized for healthcare professionals directly involved in the care of patients.

Please note, standby registration DOES NOT GUARANTEE participation in the session or meal service. If you have any questions, please feel free to contact us via email at Meetings@ResearchToPractice.com or call (800) 233-6153.