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NSCLC EGFR-Targeted Therapies: The Oncology Pharmacist's Role in Tailoring Therapy and Improving Patient Outcomes

This activity was recorded on March 29, 2017 during the HOPA Annual Meeting.

Update: On September 28, 2017, the National Comprehensive Cancer Network updated its NSCLC Clinical Practice Guidelines to include the use of osimertinib as a 1st-line treatment option for patients with locally-advanced or metastatic EGFR mutation-positive NSCLC. Subsequently, on October 9, 2017, the FDA granted Breakthrough Therapy Designation for osimertinib in the 1st-line treatment of patients with EGFR-positive NSCLC.

Release Date

April 16, 2018

Expiration Date

June 19, 2018

Target Audience

This activity is designed to meet the educational needs of oncology pharmacists.

Needs Statement

Lung cancer is the most common cancer worldwide, as well as the leading cause of cancer death.1 Non small-cell lung cancer (NSCLC) accounts for more than 85% of lung cancer cases, and is typically associated with a poor prognosis (5-year survival rate of 17.7% at diagnosis.)2,3 Historically, advanced NSCLC has had a "one-size-fits-all" treatment paradigm, with platinum-based chemotherapy being the first-line choice. The discovery of NSCLC epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations have led to the development of biomarker specific targeted therapies and the individualization of NSCLC treatment.4,5 The use of targeted therapies such as oral EGFR tyrosine kinase inhibitors (TKIs), have dramatically changed the NSCLC treatment landscape by impacting disease control, symptom palliation, and both progression-free and overall survival rates in selected patients.6 However, despite initial improvement in survival outcomes, almost all patients taking first-line EGFR TKIs eventually develop resistance to TKI therapy. The T790M mutation is a common mechanism of acquired resistance to EGFR TKIs. Increased understanding of resistance mechanisms have resulted in the development of third generation TKIs which irreversibly inhibit mutant EGFR, particularly T709M.7,8 The emergence of targeted therapies for NSCLC and advances in understanding tumor resistance mechanisms highlight the need for genotype-guided therapy and underline the importance of appropriate molecular testing to personalize lung cancer treatment.

The availability of oral chemotherapy agents such as the TKIs, has significantly changed the landscape of traditional chemotherapy management for both patients and healthcare providers. Oncology pharmacists are optimally positioned to help ensure safe ordering, dispensing, and administration of oral chemotherapy and to optimize treatment by tailoring NSCLC therapies based on molecular testing to improve patient outcomes and provide cost-effective care.9

The objective of this educational activity is to provide evidence-based information on the latest developments in NSCLC, including updates on EGFR TKIs and the importance of EGFR mutation testing to individualize NSCLC treatment. Expert faculty will examine the current role and future opportunities for oncology pharmacists to optimize the use of targeted therapies by developing strategies to minimize drug toxicities and financial burden. Cases will be used to examine contemporary challenges in managing EGFR NSCLC and highlight opportunities for oncology pharmacists to improve patient care.

1Ferlay J, et al. Int J Cancer. 2015, 2George J, et al. Nature. 2015, 3https://seer.cancer.gov/statfacts/html/lungb.html, 4Tan DS, et al. J Thorac Oncol. 2016, 5Sorber L, et al. Lung Cancer. 2016, 6Berge EM, et al. Semin Oncol. 2014, 7Hata A, et al. Cancer. 2013, 8Sequist LV, et al. N Engl J Med. 2015, 9http://www.hoparx.org/advocacy/health-policy-agenda

Learning Objectives

At the conclusion of this application-based activity, participants will be able to:

  1. Review the pathology of advanced NSCLC and examine clinically relevant molecular mutations that impact treatment strategies.
  2. Assess the targeted treatment options for advanced EGFR-mutated NSCLC, during therapy initiation and in the setting of acquired resistance, focusing on safety, efficacy, and the individualization of therapy based on tumor and patient specific factors.
  3. Examine current recommendations for molecular testing and the clinical utility of ctDNA liquid biopsy in guiding therapy, especially as it relates to EGFR T790M mutations.
  4. Explore the role of the oncology pharmacist in optimizing the use of targeted therapies for NSCLC and opportunities to advance oncology pharmacy services.
  5. Using a case-based approach, explore challenging questions regarding EGFR targeted therapy and discuss ways the oncology pharmacist can optimize therapy, manage toxicities, and play a role in improving adherence strategies.

Speakers and Bios

Val R. AdamsVal R. Adams, PharmD, FCCP, BCOP (Activity Chair)
Associate Professor of Pharmacy Practice & Science
Program Director
PGY2 Oncology Pharmacy Residency
University of Kentucky College of Pharmacy
Lexington, KY

Dr. Adams is an Associate Professor in the Department of Pharmacy Practice and Science in the College of Pharmacy at the University of Kentucky in Lexington, KY. He is on the graduate faculty and is a member of the Markey Cancer Center where he has a clinical practice site. As the Director of the Hematology/Oncology Residency Program, he has trained thirty one residents and maintains an active research lab. He received his Bachelor of Science in Pharmacy from the University of Utah and received his Doctor of Pharmacy from the University of Texas at Austin jointly with the University of Texas Health Science Center at San Antonio. He completed a residency in Hematology/Oncology at the Audie L. Murphy Memorial VA Hospital in San Antonio, Texas. He then completed a two-year Fellowship in Immunology and Transplantation at the University of Florida. Following the completion of the fellowship he joined the University of Kentucky faculty in 1996.

Josiah D. LandJosiah D. Land, PharmD, BCOP
Clinical Pharmacy Specialist
Thoracic Medical Oncology Team
Memorial Sloan Kettering Cancer Center
New York, NY

Originally from Lake Charles, LA, Dr. Land received his Bachelor of Science in Biology from McNeese State University in Lake Charles and his Doctor of Pharmacy from the University of Louisiana at Monroe in Monroe, LA. After pharmacy school, he completed a PGY1 Pharmacy Residency at The University of Texas MD Anderson Cancer Center in Houston, TX followed by a PGY2 Oncology Pharmacy Residency at Memorial Sloan Kettering Cancer Center in New York, NY. Dr. Land is currently the Clinical Pharmacy Specialist for the Thoracic Medical Oncology Service at Memorial Sloan Kettering Cancer Center in New York, NY. He is a Board Certified Oncology Pharmacist (BCOP) through the Board of Pharmacy Specialties.

Philip SchwietermanPhilip Schwieterman, PharmD, MHA
Pharmacy Director
Oncology and Infusion Pharmacy
UK HealthCare and Markey Cancer Center
Lexington, KY

Dr. Schwieterman obtained his Bachelor of Science in Pharmaceutical Science and Doctor of Pharmacy Degrees from The Ohio State University in Columbus, OH and his Master in Health Administration from the University of Kentucky in Lexington, KY. He joined UK Health-Care in 2008 where he has served in a variety of staffing, clinical and administrative roles. Dr. Schwieterman currently serves as the Director for Oncology and Infusion Pharmacy where he manages the operational, clinical, financial, and regulatory components of the UK HealthCare and Markey Cancer Center oncology pharmacy services.

Planner and Faculty Disclosures

In accordance with the Food and Drug Administration, the speakers have disclosed that there is the potential for discussions concerning off-label uses of a commercial product/device during this educational activity.

Any person who may contribute to the content of this continuing education activity must disclose relevant relationships (and any known relationships of their spouse/partner) with commercial interests whose products or services are discussed in educational presentations. A commercial interest is defined as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Relevant relationships include receiving from a commercial interest research grants, consultant fees, travel, other benefits, or having a self-managed equity interest in a company.

Disclosure of a relationship is not intended to suggest or condone any bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Adrienne Matson, PharmD, BCPS has no relevant financial relationships to disclose in relation to the content of this activity.

Val R. Adams, PharmD, FCCP, BCOP has no relevant financial relationships to disclose in relation to the content of this activity.
Josiah D. Land, PharmD, BCOP has no relevant financial relationships to disclose in relation to the content of this activity.
Philip Schwieterman, PharmD, MHA has no relevant financial relationships to disclose in relation to the content of this activity.

Accreditation Statement

In support of improving patient care, Creative Educational Concepts is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Pharmacy (ACPE)
This application-based activity is approved for 1.25 contact hours (.125 CEUs) of continuing pharmacy education credit (UAN 0245-0000-17-006-H01-P).

Internet Web Activity (Powerpoint slides and audio)

Activity Instructions

To receive a statement of credit, you must:

  • Read the target audience, learning objectives, and author disclosures.
  • Review the full content of the activity and reflect upon its teaching.
  • Complete the questions and evaluation at the end of the activity.
  • You must have a passing score of 70% on the post-test. You will have two (2) opportunities to complete