Oncology Briefings™: Integrating Novel Targeted Treatment Strategies to Advance Pancreatic Cancer Care

Release Date: November 30, 2017
Expiration Date: November 30, 2018
Media: Internet - based

Activity Overview

Oncology Briefings™ is an online interactive monograph and print supplement that includes an overview of novel chemotherapeutic and targeted therapies for the treatment of patients with metastatic pancreatic cancer. Discussion includes pharmacodynamic and pharmacokinetic rationales behind novel treatment strategies, clinical data leading to new approvals, and treatment-related adverse events to monitor. A national thought leader interprets presented data, and provides key take-home points and clinical pearls for practice to place the content into clear perspective. Audio sidebars and tables provide supporting evidence for this activity.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from Ipsen Biopharmaceuticals, Inc.

CME Activity Table of Contents

• Introduction
• Novel Chemotherapy Strategies
• Other Targeted Therapies
• Conclusion

Target Audience

This educational initiative is directed toward medical oncologists, endocrinologists, radiation oncologists, and surgeons who treat patients with pancreatic cancer. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, fellows, and other healthcare professionals interested in the treatment of pancreatic cancer are also invited to participate.

Learning Objectives

Upon completion of this activity, you should be better able to:

• Describe pharmacodynamic and pharmacokinetic approaches to the management of advanced forms of pancreatic cancer
• Report clinical trial evidence on the efficacy of liposomal irinotecan and other novel treatments for the management of metastatic pancreatic cancer
• Place clinical trial findings on novel targeted approaches into the context of evolving treatment paradigms in the field of advanced pancreatic cancer management
• Detail differential toxicity profiles and approaches in multiple lines of therapy to mitigate the impact of treatment-related adverse events in the care of patients with metastatic pancreatic cancer

Faculty, Staff, and Planners' Disclosures

Faculty

Tanios Bekaii-Saab , MD FACP
Program Co-Leader, Gastrointestinal Cancer
Mayo Clinic Cancer Center
Professor, Mayo Clinic College of Medicine and Science
Senior Associate Consultant
Division of Hematology and Oncology
Mayo Clinic 
Phoenix, Arizona 



Disclosure: Consultant: Amgen , Merck.

The staff of Physicians' Education Resource^®, LLC have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER^® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER^® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER^® is required by ACCME to resolve all COI. PER^® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic or treatment options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER^®.

PER Pulse™

PER Pulse™ Recap (1 of 3)

Oncology Briefings^™: Integrating Novel Targeted Treatment Strategies to Advance Pancreatic Cancer Care PER^® Pulse Recap

Second-Line Utility of Liposomal Irinotecan in Pancreatic Cancer

The online Oncology Briefings^™ CME activity, Integrating Novel Targeted Treatment Strategies to Advance Pancreatic Cancer Care, provides oncologists and other health care professionals with engaging instruction on the latest advancements in difficult-to-treat pancreatic ductal adenocarcinomas. Leading expert, Tanios Bekaii-Saab, MD, FACP, the program co-leader of gastrointestinal cancer at Mayo Clinic Cancer Center, professor at Mayo Clinic College of Medicine and Science, and senior associate consultant in the Division of Hematology and Oncology at Mayo Clinic in Phoenix, Arizona, answers key questions, supported by the presentation of clinical science, about pancreatic cancer. This first of 3 PER Pulse^™ Recaps from this program focuses on the use of novel chemotherapies in the second-line setting.

Dr. Bekaii-Saab detailed the pharmacokinetic rationale and utility of the novel liposomal-formulation of the chemotherapeutic agent, irinotecan, for patients with pancreatic cancer in the second-line setting:

• Irinotecan is a cytotoxic topoisomerase I inhibitor that demonstrated efficacy for patients with metastatic pancreatic cancer in the second-line setting, as a monotherapy and in combination with other agents. Limitations and adverse events (AEs) led to the development of liposomal formulations that could improve efficacy and distribution of the drug while minimizing toxicity.
• Pharmacokinetic studies have shown that the liposomal irinotecan formulation remains in circulation for a longer period compared with free irinotecan. Further, the release of irinotecan from the liposome itself increased the half-life of drug release up to nearly 57 hours.
• Liposomal irinotecan was investigated in the phase III NAPOLI-1 trial, in which 417 patients were randomized 1:1:1 to receive either nanoliposomal irinotecan (nal-IRI) monotherapy or 5-fluorouracil (5-FU) plus leucovorin (LV), or a combination of the 3.
• The median overall survival for patients receiving nal-IRI/5-FU/LV was 6.1 months compared with 4.2 months in patients not receiving nal-IRI.
• Common high-grade AEs of nal-IRI monotherapy and in combination with 5-FU and LV included neutropenia, diarrhea, fatigue, vomiting, decreased appetite, among other symptoms.
• nal-IRI was approved in combination with 5-FU and LV for the treatment of patients with metastatic pancreatic cancer with disease progression following gemcitabine-based therapy in October of 2015.

For additional information and commentary on this topic, as well as audio and supporting text, visit gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-integrating-novel-targeted-treatment-strategies-to-advance-pancreatic-cancer-care.

For information on other topics, visit gotoper.com.

PER Pulse™ Recap (2 of 3)

First-Line Utility of Nanoparticle Albumin-Bound Paclitaxel in Pancreatic Cancer

The online Oncology Briefings^™ CME activity, Integrating Novel Targeted Treatment Strategies to Advance Pancreatic Cancer Care, provides oncologists and other health care professionals with an engaging instruction on the latest advancements in difficult-to-treat pancreatic ductal adenocarcinomas. Leading expert, Tanios Bekaii-Saab, MD, FACP, the program co-leader of gastrointestinal cancer at Mayo Clinic Cancer Center, professor at Mayo Clinic College of Medicine and Science, and senior associate consultant in the Division of Hematology and Oncology at Mayo Clinic in Phoenix, Arizona, answers key questions, supported by the presentation of clinical science, about pancreatic cancer. This second of 3 PER Pulse^™ Recaps from this program focuses on the use of novel chemotherapies in the first-line setting.

Dr. Bekaii-Saab summarized the development and key trial data of the novel nanoparticle albumin-bound formulation of the chemotherapeutic agent, paclitaxel (nab-paclitaxel), for patients with pancreatic cancer in the first-line setting:

• The nab-paclitaxel formulation is designed to deliver paclitaxel to tumors via interaction with albumin receptors that mediate drug transport. Following the success of this formulation in other cancers, nab-paclitaxel was investigated in combination with gemcitabine for patients with metastatic pancreatic cancer in the phase III MPACT trial. In this trial, 861 patients were randomized to receive 125-mg/m² nab-paclitaxel plus 1000-mg/m² gemcitabine or gemcitabine alone
• Patients receiving nab-paclitaxel had an improved median overall survival of 8.5 months compared with 6.7 months for patients receiving gemcitabine alone. Progression-free survival was also higher for patients receiving the nab-paclitaxel combination than gemcitabine alone: 5.5 versus 3.7 months, respectively.
• In the MPACT trial, approximately 77% of patients receiving the nab-paclitaxel combination experienced at least 1 grade ≥3 adverse event compared with 51% of patients receiving gemcitabine monotherapy. The nab-paclitaxel combination was associated with high rates of leukopenia, neutropenia, diarrhea, fatigue, and peripheral neuropathy.
• Nab-paclitaxel was approved in combination with gemcitabine for the treatment of patients with advanced pancreatic cancer in the first-line setting in September of 2013.

For additional information and commentary on this topic, as well as audio and supporting text, visit gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-integrating-novel-targeted-treatment-strategies-to-advance-pancreatic-cancer-care.

For information on other topics, visit gotoper.com.

PER Pulse™ Recap (3 of 3)

Emerging Targeted Therapy Options for Patients With Pancreatic Cancer

The online Oncology Briefings^™ CME activity, Integrating Novel Targeted Treatment Strategies to Advance Pancreatic Cancer Care, provides oncologists and other health care professionals with engaging instruction on the latest advancements in difficult-to-treat pancreatic ductal adenocarcinomas (PDACs). Leading expert, Tanios Bekaii-Saab, MD, FACP, the program co-leader of gastrointestinal cancer at Mayo Clinic Cancer Center, professor at Mayo Clinic College of Medicine and Science, and senior associate consultant in the Division of Hematology and Oncology at Mayo Clinic in Phoenix, Arizona, answers key questions, supported by the presentation of clinical science, about pancreatic cancer. This third and final PER Pulse^™ Recap from this program focuses on emerging targeted therapies for the treatment of pancreatic cancer.

Dr. Bekaii-Saab overviewed emerging treatment options, including PARP inhibition, STAT3 inhibition, and the use of PEGPH20:

• PARP inhibitors have established clinical efficacy and demonstrated improvement in progression-free survival in multiple cancer types, including ovarian and breast cancers associated with germline BRCA1/2 mutations, or BRCAness.
• In a multitumor phase II study investigating olaparib, an objective response rate (ORR) of 21.7% was demonstrated in patients with pancreatic cancer. A phase II investigation in rucaparib, another PARP inhibitor, showed an ORR of 16% in patients with metastatic pancreatic cancer treated with at least 1 prior line of therapy.
• Napabucasin, a first-in-class cancer stemness inhibitor, is currently under development for patients with metastatic pancreatic cancer. A STAT3 inhibitor, napabucasin is able to inhibit gene transcription in cancer stem cells, slowing the growth of cancer.
• At the 2017 ESMO Congress on Gastrointestinal Cancer, results of a phase Ib/II study of napabucasin in combination with nab-paclitaxel and gemcitabine in 66 patients with metastatic PDAC were reported. The disease control rate was 93% and the ORR was 55%, including 2 complete responses.
• A pegylated recombinant form of human hyaluronidase, PEGPH20 works to prevent hyaluronan accumulation in the tumor microenvironment, reducing tumor pressure and vascular compression and increasing drug delivery of other anticancer agents.
• In the phase II HALO-109-202 study, patients receiving PEGPH20 in combination with nab-paclitaxel and gemcitabine had an ORR of 46% compared with 34% for nab-paclitaxel and gemcitabine alone.
• Further investigations in olaparib, rucaparib, napabucasin, and PEGPH20 are all underway.

For additional information and commentary on this topic, as well as audio and supporting text, visit gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-integrating-novel-targeted-treatment-strategies-to-advance-pancreatic-cancer-care.

For information on other topics, visit gotoper.com.