TARGET AUDIENCE
This educational activity has been designed to meet the educational needs of medical oncologists, hematology-oncology fellows and other allied cancer professionals involved in the treatment of lung cancer.

OVERVIEW OF ACTIVITY
Lung cancer is a devastating disease with broad-reaching impact on public health as it accounts for 14% of all new cancer cases in the United States and the most cancer-related deaths among both men and women. In the year 2018, it is estimated that more than 234,030 individuals will be diagnosed and more than 154,050 will die from the disease. Importantly, despite the many advances over the past few decades related to surgery, radiation therapy and chemotherapy, death rates attributable to lung cancer have remained relatively unchanged. Today, however, this field is seeing renewed optimism that these trends have already started to change as recent research advances have led to an explosion in lung cancer genetic and biologic knowledge among scientists and clinicians working in this area of cancer medicine. Over the past several years major clinical trials in lung cancer have witnessed a host of promising successes, many of which are already being operationalized in clinical practice. Even so, these achievements will doubtlessly continue to be dissected in the upcoming years and will further challenge the collective understanding of the biology and optimal management of this disease. Several consensus- and evidence-based treatment guidelines are currently available and aim to assist clinicians with making lung cancer treatment decisions in the face of this dynamic clinical environment, but despite the existence of these tools, many areas of controversy persist within academic and community settings.

These video proceedings from a live CME symposium feature the perspectives of a multidisciplinary panel of clinical investigators on key challenges and controversies in the treatment of lung cancer. By providing information on the latest research developments and their potential application to routine practice, this activity will assist medical oncologists, hematology-oncology fellows and other allied cancer professionals in staying up to date in a continuously evolving therapeutic environment.

LEARNING OBJECTIVES

• Design evidence-based strategies for the diagnosis and management of Stage I to Stage III non-small cell lung cancer (NSCLC), considering the potential contributions of systemic and/or local therapeutic modalities.
• Appreciate the FDA approval of durvalumab and available Phase III data documenting the benefit of sequential anti-PD-L1 therapy after the completion of chemoradiation therapy for Stage III NSCLC, and consider the role of this therapeutic approach for appropriate patients.
• Recognize available and emerging research information validating the utility of diagnostic assays designed to measure EGFR, ALK, ROS1, BRAF and PD-L1 status, select optimal testing platforms and appropriately apply the results to individualize first- and later-line therapy for patients with NSCLC according to their potential response or resistance to a specific treatment.
• Review published research data documenting the safety and efficacy of anti-PD-1/PD-L1 antibodies used as monotherapy or in combination with chemotherapy for patients with newly diagnosed metastatic NSCLC.
• Consider age, performance status, PD-L1 tumor proportion score and other patient or disease characteristics to guide the selection of induction and maintenance systemic therapy for patients with metastatic NSCLC without an identifiable driver mutation.
• Employ an understanding of personalized medicine to individualize the use of available EGFR inhibitors in the long-term management of EGFR mutation-positive NSCLC.
• Communicate the efficacy and safety of approved and investigational ALK inhibitors to appropriate patients with NSCLC, considering the predictive utility of ALK mutation testing.
• Assess other oncogenic pathways mediating the growth of tumors in unique subsets, and recall emerging data with commercially available and experimental agents exploiting these targets.
• Describe ongoing trials evaluating novel applications of immune checkpoint inhibitors alone or in combination with other systemic approaches (eg, anti-PD-1/PD-L1 antibodies in combination with other checkpoint inhibitors, chemotherapy or targeted therapy) for diverse lung cancer variants, and counsel appropriately selected patients about participation.
• Formulate management strategies for small cell lung cancer, considering the contributory roles of local and systemic therapy in addition to current research studies evaluating novel immunotherapeutic and targeted approaches.
• Consider the use of multimodality therapy for appropriate patients with mesothelioma who might be cured with this approach, and devise optimal management strategies for those with advanced disease, including the option of clinical trial participation.

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:

Ethan M Basch, MD, MSc
Professor of Medicine and Public Health
Director, Cancer Outcomes Research Program
Co-Leader, Cancer Prevention and Control
Associate Chief, Division of Oncology
University of North Carolina
Chapel Hill, North Carolina

No relevant conflicts of interest to disclose.

Jeffrey Crawford, MD
George Barth Geller Professor for Research in Cancer
Co-Director, Solid Tumor Therapeutics Program
Duke Cancer Institute
Durham, North Carolina

Advisory Committee: AstraZeneca Pharmaceuticals LP, Merck, Pfizer Inc; Data and Safety Monitoring Board: BeyondSpring Pharmaceuticals, Celgene Corporation, G1 Therapeutics, Genentech, Janssen Biotech Inc, Merrimack Pharmaceuticals Inc, Mylan Pharmaceuticals Inc, Roche Laboratories Inc.

Jesse R Fann, MD, MPH
Director, Psychiatry and Psychology Service
Seattle Cancer Care Alliance
Clinical Research Division
Fred Hutchinson Cancer Research Center
Professor, Department of Psychiatry and Behavioral Sciences
University of Washington
Seattle, Washington

Consulting Agreements: Quartet Health; Stock Ownership: Pfizer Inc.

Leena Gandhi, MD, PhD
Director, Perlmutter Cancer Center
Langone Health
New York University
New York, New York

Advisory Committee: AstraZeneca Pharmaceuticals LP, Genentech, Ignyta Inc, Merck, Syndax Pharmaceuticals Inc.

Edward B Garon, MD, MS
Associate Professor
Director, Thoracic Oncology Program
Jonsson Comprehensive Cancer Center
David Geffen School of Medicine at UCLA
Los Angeles, California

Contracted Research: AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Genentech, Lilly, Merck, Mirati Therapeutics, Novartis, Pfizer Inc.

Matthew Gubens, MD, MS
Associate Professor, Thoracic Medical Oncology
University of California, San Francisco
San Francisco, California

Advisory Committee: AbbVie Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Genentech, Mersana Therapeutics, Novartis; Contracted Research: Celgene Corporation, Merck, OncoMed Pharmaceuticals Inc, Roche Laboratories Inc.

Nasser H Hanna, MD
Associate Professor of Medicine
Indiana University
Indianapolis, Indiana

Contracted Research: Bristol-Myers Squibb Company, Merck.

Jennifer M Kapo, MD
Associate Professor of Medicine (Geriatrics)
Chief, Palliative Medicine
Smilow Cancer Hospital
Yale Cancer Center
New Haven, Connecticut

No relevant conflicts of interest to disclose.

Rogerio C Lilenbaum, MD (Co-Chair and Moderator)
Professor of Medicine
Yale School of Medicine
Chief Medical Officer
Smilow Cancer Hospital
Yale Cancer Center
New Haven, Connecticut

Advisory Committee: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Genentech; Consulting Agreement: Roche Laboratories Inc; Contracted Research: Celgene Corporation.

Billy W Loo Jr, MD, PhD, DABR
Associate Professor, Thoracic Radiation Oncology Program Leader
New Technologies Committee Co-Chair
Department of Radiation Oncology
Stanford Cancer Institute
Stanford, California

Board Member and Ownership Interest: TibaRay Inc.

Gregory J Riely, MD, PhD
Associate Attending
Memorial Sloan Kettering Cancer Center
New York, New York

Contracted Research: Genentech, Pfizer Inc, Takeda Oncology; Paid Travel: Merck; Other: AstraZeneca Pharmaceuticals LP.

Naiyer Rizvi, MD
Professor of Medicine
Director of Thoracic Oncology and Phase I Immunotherapeutics
Price Chair in Clinical Translational Research
Columbia University Medical Center
New York, New York

Advisory Committee: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, EMD Serono Inc, Genentech, GlaxoSmithKline, Janssen Biotech Inc, Lilly, Merck, Novartis, Pfizer Inc, Roche Laboratories Inc.

Lecia V Sequist, MD, MPH
Associate Professor of Medicine
Harvard Medical School
Center for Thoracic Cancers
Massachusetts General Hospital Cancer Center
Boston, Massachusetts

Consulting Agreements: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Genentech, Merrimack Pharmaceuticals Inc, Pfizer Inc; Contracted Research: AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Genentech, Merrimack Pharmaceuticals Inc, Novartis.

Mark A Socinski, MD (Co-Chair and Moderator)
Executive Medical Director
Member, Thoracic Oncology Program
Florida Hospital Cancer Institute
Orlando, Florida

Advisory Committee: AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Pfizer Inc; Contracted Research: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Celgene Corporation, Genentech; Speakers Bureau: AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Genentech, Lilly, Takeda Oncology.

Anne S Tsao, MD
Professor
Director, Mesothelioma Program
Director, Thoracic Chemo-Radiation Program
The University of Texas MD Anderson Cancer Center
Department of Thoracic/Head and Neck Medical Oncology
Houston, Texas

Advisory Committee: Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, EMD Serono Inc, Genentech, Lilly, Merck, Novartis, Roche Laboratories Inc, Takeda Oncology; Contracted Research: Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Genentech, Lilly, Merck.

Douglas E Wood, MD
The Henry N Harkins Professor and Chair
Department of Surgery
University of Washington
Seattle, Washington

No relevant conflicts of interest to disclose.

MODERATOR AND CO-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, 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 AbbVie Inc, AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Exelixis Inc, Foundation Medicine, Genentech, Lilly, Novartis and Takeda Oncology.

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

Release date: April 2018
Expiration date: April 2019