The Path Forward in Advanced HER2+ Gastric Cancer: More Options, More Decisions

The Path Forward in Advanced HER2+ Gastric Cancer: More Options, More Decisions

Med-IQ Select
Online Course | Specialties: Gastroenterology, Oncology
Released: 8/31/2020
Expires: 8/30/2021
Max Credits: 0.5
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Johanna Bendell, MD
Chief Development Officer
Director, Drug Development Unit Nashville
Sarah Cannon Research Institute
Tennessee Oncology
Nashville, TN

Activity Planners
Iwona Misiuta, PhD, MHA
Clinical Content Manager
Baltimore, MD

Lisa R. Rinehart, MS, ELS
Director, Editorial Services
Baltimore, MD

Samantha Gordon
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM
Associate Director, Education Quality and Compliance
East Lansing, MI

Jennifer L. Gregg, PhD
Atlas Medical Writing
Cranberry Township, PA

Learning Objectives
Upon completion, participants should be able to:

  • Assess the efficacy and safety of novel HER2-targeted therapy in clinical development for previously treated HER2-positive gastric or gastroesophageal junction adenocarcinoma
  • Consider the clinical implications of emerging evidence with novel HER2-targeting therapies for HER2-expressing gastric or gastroesophageal junction adenocarcinoma as they become available, including in the context of optimal sequential use of treatments and key counseling points for patients

Target Audience
This activity is intended for oncologists, oncology nurses, nurse practitioners, and physician assistants.

Statement of Need
Despite advances in the understanding of the pathogenesis and heterogeneity of gastric and gastroesophageal junction (GEJ) cancers, survival rates worldwide remain dismally low. Gastric cancer is usually discovered late in the disease course and, though incidence has been declining in recent years, it is still the fifth-leading cause of cancer worldwide.

Advances in the molecular characterization and approval of targeted therapies have shifted the treatment landscape of gastric and GEJ adenocarcinoma toward a more individualized approach. Guidelines recommend screening patients with suspected or documented metastatic disease for prognostic biomarkers, such as human epidermal growth factor receptor 2 (HER2) overexpression or amplification, to aid with treatment selection. Although trastuzumab, a HER2-directed treatment, has revolutionized the management of HER2-positive gastric cancer, intrinsic and acquired resistance is common, resulting in the need to find novel agents that can overcome this resistance. However, subsequent lines of treatment do not consider HER2 tumor status for treatment selection.

Novel agents targeting HER2 are demonstrating promising results in clinical trials in patients with HER2-positive relapsed/refractory gastric cancer. Given the rapid pace of clinical advances, oncology professionals require education to stay up-to-date on clinical data to optimize the care of their patients with HER2-positive gastric cancer and to assess how emerging anti-HER2 agents have the potential to affect the current standard of care.

Providership Statement
Provided by Med-IQ. 

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Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Med-IQ designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Med-IQ is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This nursing activity has been approved for up to 0.5 contact hour.

Nurse practitioners, physician assistants, and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Medium/Method of Participation
This is a 0.5-credit CME activity. To receive credit, read the introductory CME material, complete all of the modules, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: August 31, 2020
Expiration Date: August 30, 2021
Estimated Time to Complete This Activity: 30 minutes

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Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Johanna Bendell, MD, has indicated no real or apparent conflicts.

The writer, peer reviewers, and activity planners have no financial relationships to disclose.

Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

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Acknowledgment of Commercial Support
This activity is supported by educational grants from AstraZeneca Pharmaceuticals and Daiichi Sankyo Inc.

© 2020 Med-IQ, Inc.


Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the continue button below.

Module 1: Current First-Line Treatment Options

  • Patients with advanced gastric cancer should be tested for HER2 status before first-line therapy begins
  • If a tumor is determined to be HER2 positive, trastuzumab plus fluoropyrimidine and platinum therapy should be given
  • Current standard treatment approaches beyond the first-line setting revert to standard therapies for non–HER2-expressing gastric cancer

Module 2: Novel Treatments in Development

  • Multiple anti-HER2 therapies are under investigation in patients with advanced gastric cancers who have been previously treated with trastuzumab
  • Suboptimal results in clinical trials with HER2-targeted therapy in advanced gastric cancer (eg, phase 2/3 GATSBY, phase 3 TyTAN, phase 2 T-ACT) may be attributed to resistance to HER2-targeted therapy and loss of HER2 protein expression
  • Positive results in clinical trials include DESTINY-Gastric01 with the off-label use of fam-trastuzumab deruxtecan-nxki; the phase 2, open-label, dose-escalation study of margetuximab; and the phase 1 trial of ZW25

Module 3: Important Clinical Considerations

  • Research has focused on identifying molecular and genetic drivers in gastric cancer not only to improve sensitivity to existing regimens but also to select suitable sequential treatment options
  • NCCN guidelines support biomarker testing for patients with advanced gastric disease including HER2 status, MSI status, and PD-L1 expression
  • Clinicians should regularly use validated surveys and questionnaires to assess disease- and treatment-related symptoms and quality of life
  • HER2-targeted therapies are generally well tolerated, although cardiotoxicities have been reported and should be monitored for carefully during treatment
  • Building a multidisciplinary care team is a critical aspect of patient care

View reference list.

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