TARGET AUDIENCE
This activity is intended for medical oncologists and other healthcare providers involved in the treatment of gastrointestinal (GI) cancers.

OVERVIEW OF ACTIVITY
The pace of oncology drug development has accelerated in recent years to previously unmatched levels. Fueled by an increased understanding of the biologic underpinnings of tumor development and progression, clinical research platforms largely focused on evaluating the potential benefits of novel targeted therapeutics possessing unique mechanisms of action and safety profiles have led to improved outcomes in a myriad of large and rigorous clinical trials. Although this dynamic appears to be prevalent in many corners of oncology, recent advancements in the management of several prominent GI cancers have made it particularly pronounced in this area.

The successes yielded by this rational approach to the design and evaluation of new therapies have provided medical oncologists and patients with many beneficial treatments, but the availability of this growing list of novel options may also pose a challenge to the practicing clinician who must maintain knowledge of appropriate clinical management strategies across a vast spectrum of liquid and solid tumors. To bridge the gap between research and patient care, this video presentation by Philip A Philip uses a review of recent relevant publications and presentations, ongoing clinical trials and clinical investigator treatment preferences to assist medical oncologists and other healthcare providers involved in the treatment of GI cancers with the formulation of up-to-date clinical management strategies.

LEARNING OBJECTIVES

• Appraise the biologic rationale for and available clinical data with approved and investigational anti-PD-1 and/or anti-PD-L1 antibodies in the treatment of select GI cancers.
• Appreciate the rationale for and clinical evidence supporting the integration of novel treatment approaches for early pancreatic cancer.
• Recognize the mechanism of action of and available data with nanoliposomal irinotecan in the management of treatment-refractory metastatic pancreatic cancer, and develop strategies to incorporate this agent into patient-care algorithms.
• Consider available clinical research data documenting the efficacy of ramucirumab in metastatic colorectal and gastric or gastroesophageal junction cancers, and discern how this agent can be optimally integrated into clinical practice for patients with these diseases.
• Formulate a plan to include information about the left or right sidedness of colon cancer tumors in prognostication and systemic treatment decision-making.
• Develop an understanding of emerging Phase III efficacy data with commercially available multikinase inhibitors (eg, regorafenib and lenvatinib) for the management of relapsed/refractory hepatocellular carcinoma.
• Evaluate available Phase III data with peptide receptor radionuclide therapy with ¹⁷⁷Lu-Dotatate for patients with GI neuroendocrine tumors progressing on somatostatin analogue therapy.
• Appreciate the FDA-approved indication for telotristat ethyl, and consider this information in the selection of patients with carcinoid syndrome-associated diarrhea who might benefit from treatment with this agent.
• Recall available and emerging data with other investigational agents currently in Phase III testing for various GI cancers, and, where applicable, refer eligible patients for trial participation or expanded access programs.

ACCREDITATION STATEMENT
Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
CME credit is no longer available for this issue

AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) — MAINTENANCE OF CERTIFICATION (MOC)
CME credit is no longer available for this issue

HOW TO USE THIS CME ACTIVITY
This CME activity consists of a video component.
CME credit is no longer available for this issue

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 conflicts of interest with faculty, planners and managers of CME activities. 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 physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

Presenting Faculty Member

Philip A Philip, MD, PhD
Professor of Oncology and Pharmacology
Director of GI and Neuroendocrine Tumors
Vice President of Medical Affairs
Karmanos Cancer Institute
Wayne State University
Detroit, Michigan

Advisory Committee: Bayer HealthCare Pharmaceuticals, Celgene Corporation, Genentech BioOncology, Halozyme Inc, Lilly, Merrimack Pharmaceuticals Inc, Novartis; Consulting Agreements: Celgene Corporation, Halozyme Inc, Lilly; Contracted Research: Bayer HealthCare Pharmaceuticals, Celgene Corporation, Lilly, Merck, Novartis; Speakers Bureau: Amgen Inc, Bayer HealthCare Pharmaceuticals, Celgene Corporation, Genentech BioOncology, Lilly, Merrimack Pharmaceuticals Inc, Novartis, Sanofi Genzyme.

Project Steering Committee Members

Tanios Bekaii-Saab, MD
Professor, Mayo Clinic College of Medicine and Science
Co-Leader, GI Cancer Program
Mayo Clinic Cancer Center
Senior Associate Consultant
Mayo Clinic Arizona
Scottsdale, Arizona

Consulting Agreements: Amgen Inc, ARMO BioSciences, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Celgene Corporation, Exelixis Inc, Genentech BioOncology, Ipsen Biopharmaceuticals Inc, Merck, Roche Laboratories Inc, SillaJen; Contracted Research: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Lilly.

Johanna C Bendell, MD
Director, GI Oncology Research
Associate Director, Drug Development Unit
Sarah Cannon Research Institute
Nashville, Tennessee

Contracted Research: Abbott Laboratories, AbbVie Inc, Apexigen, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Eisai Inc, EMD Serono Inc, Five Prime Therapeutics Inc, Forty Seven Inc, Genentech BioOncology, Gilead Sciences Inc, GlaxoSmithKline, Incyte Corporation, Kolltan Pharmaceuticals Inc, Leap Therapeutics Inc, Lilly, MacroGenics Inc, MedImmune Inc, Merck, Novartis, OncoMed Pharmaceuticals Inc, Onyx Pharmaceuticals, an Amgen subsidiary, Pfizer Inc, Roche Laboratories Inc, Sanofi Genzyme, Stemcentrx, Taiho Oncology Inc, Takeda Oncology, TG Therapeutics Inc.

Axel Grothey, MD
Professor of Oncology
Department of Medical Oncology
Mayo Clinic
Rochester, Minnesota

Advisory Committee: Amgen Inc, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Genentech BioOncology, Roche Laboratories Inc; Contracted Research: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Eisai Inc, Genentech BioOncology.

Howard S Hochster, MD
Associate Director (Clinical Research), Yale Cancer Center
Professor of Medicine, Yale School of Medicine
New Haven, Connecticut

Consulting Agreements: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Genomic Health Inc.

Heinz-Josef Lenz, MD
Professor of Medicine and Preventive Medicine
J Terrence Lanni Chair in Cancer Research
Co-Director, USC Center for Molecular Pathways and Drug Discovery
Keck School of Medicine, University of Southern California
Associate Director of Adult Oncology
Co-Director, Colorectal Center
Scientific Director, Cancer Genetics Unit
USC/Norris Comprehensive Cancer Center
Los Angeles, California

Advisory Committee and Consulting Agreements: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, EMD Serono Inc, Genentech BioOncology, Roche Laboratories Inc; Contracted Research: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, EMD Serono Inc, Genentech BioOncology, Merck, Roche Laboratories Inc.

Bert H O’Neil, MD
Professor of Medicine
Director, Phase I and GI Malignancies Programs
Indiana University Simon Cancer Center
Indianapolis, Indiana

Advisory Committee: Amgen Inc, Bayer HealthCare Pharmaceuticals, Genentech BioOncology; Speakers Bureau: Bayer HealthCare Pharmaceuticals.

PROJECT CHAIR — 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, Acerta Pharma, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals Inc.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no relevant conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Boston Biomedical Pharma Inc, Exelixis Inc, Lexicon Pharmaceuticals Inc, Lilly, Merck and Merrimack Pharmaceuticals Inc.

Hardware/Software Requirements:
A high-speed Internet connection
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
Adobe Flash Player 27 plug-in or later
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio

Last review date: February 2018
Expiration date: February 2019