Caring for Patients With Lung Cancer and Targetable Mutations: Guidance on <em>EGFR, ALK</em>, and <em>ROS1</em>

Caring for Patients With Lung Cancer and Targetable Mutations: Guidance on EGFR, ALK, and ROS1

Expiring Soon
Online Course | Specialties: Oncology
Released: 9/24/2020
Expires: 9/23/2021
Max Credits: 0.5
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Faculty Chair
Suresh S. Ramalingam, MD 
Professor of Hematology and Medical Oncology 
Emory University School of Medicine 
Winship Cancer Institute 
Atlanta, GA

Jennifer W. Carlisle, MD
Assistant Professor
Department of Hematology and Medical Oncology
Emory University School of Medicine 
Winship Cancer Institute 
Atlanta, GA
Activity Planners
Christie Avraamides, PhD
Clinical Content Manager
Baltimore, MD

Laura Rafferty, ELS
Senior Managing Editor
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Eileen McCaffrey, MA
Whippany, NJ

Learning Objectives
Upon completion, participants should be able to:

  • Identify evidence-based first-line and subsequent lines of therapy for advanced NSCLC according to patient- and tumor-related factors, including molecular markers
  • Implement clinical evidence on tissue- and blood-based molecular testing in advanced NSCLC at diagnosis and following disease progression
  • Apply best practices to facilitate prompt molecular testing in advanced NSCLC in a community setting 

Target Audience
This activity is intended for medical oncologists, nurse practitioners, physician assistants, pathologists, interventional radiologists, and other healthcare providers who treat and/or manage patients with lung cancers. 
Statement of Need
Targeted therapy with a tyrosine kinase inhibitor (TKI) is the standard of care when molecular aberrations such as epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) or ROS proto-oncogene 1 (ROS1) gene rearrangements are discovered in patients with advanced non–small cell lung cancer (NSCLC). Many patients, however, do not receive optimal therapy because of a failure to test for the relevant molecular markers or a failure to select and sequence therapy appropriately. In the last few years, a variety of TKIs have been approved, and a wealth of data on first-line and subsequent lines of therapy has emerged. These developments have created challenges in the selection and sequencing of therapy for this patient population. Clinicians must stay current on the latest advances with these agents and understand differences in safety and efficacy in order to provide high-quality, personalized care to patients with advanced NSCLC across lines of treatment.

Providership Statement
Provided by Med-IQ.
Accreditation/Designation Statements
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.

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 CME activity consists of a 0.5-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly. 

Initial Release Date: September 24, 2020
Expiration Date: September 23, 2021
Estimated Time to Complete This Activity: 30 minutes

Disclosure Policy
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. 

Jennifer W. Carlisle, MD, has indicated no real or apparent conflicts.

Suresh S. Ramalingam, MD 
Consulting fees/advisory boards: AbbVie Inc., Amgen, AstraZeneca, Bristol-Myers Squibb, F. Hoffmann-La Roche Ltd., Genentech, Merck & Co., Inc., Takeda Pharmaceuticals North America, Inc. 

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.
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.
Contact Information        
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Acknowledgement of Commercial Support
This activity is supported by educational grants from AstraZeneca and Genentech.
© 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.

  • All patients with metastatic NSCLC should undergo molecular profiling before starting therapy
  • If liquid biopsy is performed, a negative finding should be further investigated with tissue-based testing; treatment should be started after tissue-based results are available, unless clinically inappropriate due to the patient’s disease course
  • Biopsy is encouraged for patients who develop resistance to EGFR TKIs to determine appropriate next steps based on the mechanism of resistance
  • Guidelines recommend the following first-line treatments for patients with these mutations:
    • EGFR—osimertinib (preferred), erlotinib, afatinib, gefitinib, dacomitinib, or erlotinib plus ramucirumab
    • ALK—alectinib (preferred), brigatinib, or ceritinib
    • ROS1—crizotinib or entrectinib (preferred), or ceritinib

View reference list.

Click “Continue” to proceed through this activity and/or receive credit. To receive credit and a certificate, you must complete all of the chapters in this activity.”

By clicking "Continue," you confirm that you have reviewed the CME information.


Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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