History of Present Illness:

Jean is a 60-year-old Caucasian female, never smoker, who returns today for her 6 month follow up with her oncologist. She was diagnosed with stage IIA adenocarcinoma of the right lung 6 months ago. Since then, she underwent a right lobectomy followed by adjuvant platinum-based doublet chemotherapy with vinorelbine. Her first follow up CT scan 3 months post chemotherapy was reportedly negative. She returns today for a follow up visit one week after a new CT scan reveals a new left adrenal mass and a suspicious bone metastases in the lumbar vertebrae 4 and 5. Her ECOG/WHO performance status scale is 1.

Accreditation Statement:

University of Medicine & Dentistry of New Jersey (UMDNJ)-Center for Continuing and Outreach Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Disclosure Statement:

As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of UMDNJ to require that everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest (entities producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients) within the past 12 months, and identify and resolve all conflicts of interest prior to the educational activity.

The following disclosure declarations were reported:

Faculty
Edward B. Garon, MD has no relevant financial relationships to disclose.

Independent Reviewer
Biren Saraiya, MD has no relevant financial relationships to disclose.

Field Testers
Ahmit Mehta, MD and Evan C. Naylor, MD have no relevant financial relationships to disclose.

Planners
Dalia Mobarek, MD, Medical Director; Carolyn Darrow, MPH, CME Compliance Officer, and Daryl Lynn Ehrentreu, RPh, MBA, Program Manager of MedCases LLC, have no relevant financial relationships to disclose.

Patrick Dwyer, Director, CME, Elizabeth Ward, Assistant Director, CME Compliance, and Felicia James, Program Manager, of UMDNJ-Center of Continuing and Outreach Education, have no relevant financial relationships to disclose.

Notice of Off-Label Use Presentations

In accordance with US Food and Drug Administration (FDA) requirements regarding the disclosure of off-label, investigational, or unapproved recommendations for the use of drugs or devices, you are advised that content in this activity does contain reference(s) to uses of drugs or devices that are off-label, investigational, or unapproved in the United States. The following information is provided for educational purposes and not to endorse off-label use.

Pemetrexed as a single agent in third line setting is not included in the labeling approved by the US FDA for the treatment of NSCLC.

Method of Participation:

This Internet-based activity takes approximately 0.75 hours to complete. You should review the important information on this page, check the box below and click the button to proceed to the case. First-time visitors will be asked to complete their profile. After completing the activity you will answer a multiple-choice post-test and complete an evaluation form online. Once completed, you will be able to save your certificate to your own computer and print it on your own printer.

Statement of Responsibility:

UMDNJ and MedCases take responsibility for the content, quality, and scientific integrity of this CME activity.

Principal Faculty:

Edward B. Garon, MD
Assistant Professor Division of Hematology/Oncology
David Geffen School of Medicine at UCLA
Los Angeles, California

Independent Reviewer:

This activity was peer-reviewed for relevance, accuracy of content and balance of presentation by:

Biren Saraiya, MD
Assistant Professor of Medicine
UMDNJ-Robert Wood Johnson Medical School
The Cancer Institute of New Jersey
New Brunswick, New Jersey

Field Testers:

This activity was pilot-tested for time required for participation by:

Saurabh Chhabra, MD
Hematology/Oncology Fellow, Department of Medicine
UMDNJ-Robert Wood Johnson Medical School
New Brunswick, New Jersey

Yujie Zhao, MD
Hematology/Oncology Fellow, Department of Medicine
UMDNJ-Robert Wood Johnson Medical School
New Brunswick, New Jersey

Target Audience:

This activity is intended for medical oncologists, surgical oncologists, radiation oncologists, pathologists, and all other healthcare professionals managing patients with NSCLC.

Prerequisites:

There are no prerequisites.

Statement of Need:

Despite the research efforts over the past several years that have enabled profound changes in the approach to NSCLC, the prognosis for the 50% of patients who present with locally advanced or metastatic disease remains poor. No single regimen has proven superior in the NSCLC population at large and usual time to progression is 4-6 months, with 30-40% of patients alive after 1 year (compared to 15% without chemotherapy), and only 10-15% are alive after 2 years. New approaches to NSCLC are critically needed to improve patient outcomes. An increased understanding of tumor biology and the development of targeted agents continues to improve these outcomes. Physicians need to know data supporting the role of such agents. A vigorous research effort has produced increased understanding of tumor biology, and the development of new agents directed at molecular targets. With these advances, the target audience may be required to change the current practice patterns. Our analysis of the science and evidence-based treatment approaches for the management of NSCLC, specifically the examination of clinical trial endpoints and identification of appropriate treatment regimens, constitutes a need in the continuing education of oncology healthcare professionals.

Objectives:

• Discuss appropriate endpoint determinants for clinical trials evaluating therapies for NSCLC
• Describe the role of EGFR mutation testing for the management of selected patients with NSCLC
• Discuss emerging and evidence-based strategies for the treatment of patients with recurrent and progressive NSCLC
• Analyze the current role of novel biologic and targeted agents; including indication efficacy, and toxicity based on current clinical evidence
• Describe the role of combination and multimodality therapy in optimizing outcomes in patients with NSCLC
• Summarize appriopriate first-, second-, and third-line treatment, as well as new investigational protocols for patients with advanced NSCLC

Disclaimer:

The opinions and recommendations expressed by faculty whose input is included in this program are their own. It should not be inferred or assumed that they are expressing the views of Boehringer Ingelheim Corporation, any other manufacturer of pharmaceuticals, UMDNJ, or MedCases. This enduring material is produced for educational purposes only. Use of MedCases’ name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

All information contained within this activity is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained in this site because no single reference or service can take the place of medical training, education and experience. Consumers are cautioned that this site is not intended to provide medical advice about any specific medical condition they may have or treatment they may need and they are encouraged to call or see their physician or other health care provider promptly with any health related questions they may have.

This UMDNJ certified CME activity and the MedCases Web site does not define a standard of care, nor is it intended to dictate an exclusive course of management. Cases are provided for informational and educational purposes only and are not intended as medical advice. This information should not substitute for a visit or consultation with a health care provider.

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Copyright Information:

Copyright © 2010 MedCases, LLC and UMDNJ-Center for Continuing and Outreach Education. All rights reserved.

For Further Information:

MedCases 
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Phone (609) 454-0680 
Fax (609) 951-0112 
cme@medcases.com 

Please direct CME related questions to UMDNJ at 973-972-4267 or email ccoe@umdnj.edu.

Hardware/Software Requirements and Technical Assistance: