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About This Activity

Activity Description and Learning Objectives

In this activity, experts in NSCLC discuss the latest developments in NSCLC with MET exon 14 skipping alterations. This activity was recorded at the European Society for Medical Oncology (ESMO) Annual Meeting in Barcelona 27 September–1 October 2019.

This activity has been jointly provided by Oakstone and touchIME ONCOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

After watching this activity, participants should be able to:

Target Audience

This activity has been designed to meet the educational needs of oncologists, nurse specialists, pathologists and other allied healthcare professionals involved in the management of NSCLC.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Prof. David Planchard discloses Consultant/Advisory Board positions with AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Daiichi Sankyo, Eli Lilly, MedImmune, Merck, Novartis, Peer CME, Pfizer, prIME Oncology and Roche.

Prof. Enriqueta Felip has been an advisor or speakers’ bureau member for AbbVie, AstraZeneca, BerGenBio, Blueprint Medicines, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Guardant Health, Janssen, Medscape, Merck KGaA, Merck Sharp & Dohme, Novartis, Pfizer, priME Oncology, Roche, Samsung, Takeda and touchIME. She has been an independent Board member of Grifols and has received research funding from Fundación Merck Salud, Grant for Oncology Innovation EMD Serono.

Prof. Frank Griesinger has disclosures from the following companies: Abbvie, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Chugai, Lilly, Medac, Merck, MSD, Novartis, Pfizer, Roche and Takeda.

Prof. Marina Garassino discloses honoraria from AstraZeneca/MedImmune, Bristol-Myers Squibb, GlaxoSmithKline, MSD Oncology, Roche and Takeda, has performed Consulting or Advisory roles for AstraZeneca, Bristol-Myers Squibb, MSD, Novartis, Roche, Sanofi-Aventis, Takeda and Tiziana Life Sciences, and has been a member of speakers’ bureaux for AstraZeneca, Bristol-Myers Squibb, Celgene, Incyte MSD Oncology, Roche and Takeda; her Institution has received research funding from AstraZeneca/MedImmune, AstraZeneca, Blueprint Medicines, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Incyte, Merck, MSD, Novartis, Pfizer, Roche/Genentech, Spectrum Pharmaceuticals and Takeda.

Prof. Johan Vansteenkiste discloses honoraria/consultation fees from Apotex, AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Roche, and Research grants/support from MSD.

Content Reviewer

Walter Murray Yarbrough, MD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Martin Quinn has no financial interests/relationships or affiliations in relation to this activity.

Requirements for successful completion

Oakstone Publishing designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™️. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. A score of 70% or higher is needed to obtain CME credit. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: October 22, 2019. Date credits expire: October 22, 2020.

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CME Post-test

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Q1. What should you consider as a likely cause of peripheral oedema in a patient with NSCLC who is receiving a MET inhibitor?

  1. Nephrotoxicity due to the MET inhibitor
  2. Class effect adverse event associated with MET inhibitors
  3. Sudden declining cardiovascular health of the patient
  4. Disease progression

Please try again

Peripheral oedema is a common adverse event associated with MET inhibitors.1-4

References
1. Drilon A, et al. Efficacy and safety of crizotinib in patients (pts) with advanced MET exon 14-altered non-small cell lung cancer (NSCLC). J Clin Oncol. 2016;34(suppl):abstract 108
2. Paik PK, et al. Phase II study of tepotinib in NSCLC patients with METex14 mutations. Presentation at 2019 ASCO Annual Meeting; abstract 9005.
3. Wolf J, et al. Capmatinib (INC280) in METΔex14-mutated advanced non-small cell lung cancer. (NSCLC): Efficacy data from the phase II GEOMETRY mono-1 study. Presentation at 2019 ASCO Annual Meeting; abstract 9004.
4. Lu S, et al. Preliminary efficacy and safety results of savolitinib treating patients with pulmonary sarcomatoid carcinoma (PSC) and other types of non-small cell lung cancer (NSCLC) harboring MET exon 14 skipping mutations. Proceedings: AACR Annual Meeting 2019:abstract CT031.

Q2. Which of the following is a recognised mechanism of resistance to EGFR inhibitors in patients with NSCLC?

  1. ROS1 rearrangement
  2. MET amplification
  3. ALK translocation
  4. MET exon 14 skipping mutation

Please try again

Activation of alternative pathways is a common resistance mechanism to EGFR-TKIs; in particular, amplification of the MET oncogene accounts for 5–20% of acquired resistance causes.

Reference
Morgillo F, et al. Mechanisms of resistance to EGFR targeted drugs: lung cancer. ESMO Open 2016;1:e000060.

Q3. Which of the following MET inhibitors is the least selective for MET?

  1. Tepotinib
  2. Capmatinib
  3. Crizotinib
  4. Savolitinib

Please try again

The selective MET inhibitors tepotinib, capmatinib and savolitinib have lower IC50 for MET than the multikinase inhibitor crizotinib.

Reference
Rehman S and Dy GK. MET Inhibition in Non-Small Cell Lung Cancer. EMJ Respir. 2018;6:100–111.

Q4. Which of the following agents have shown similar activity in patients with MET exon 14-skipping NSCLC with or without brain metastases (as of August 2019)?

  1. Crizotinib and capmatinib
  2. Tepotinib and capmatinib
  3. Crizotinib and savolitinib
  4. Savolitinib and tepotinib

Please try again

Both tepotinib and savolitinib have reported that the presence of brain metastases at baseline did not affect the efficacy of these agents in patients with MET exon 14-skipping NSCLC.1,2 Corresponding data have yet to be reported for crizotinib and savolitinib.

References
1. Paik PK, et al. Phase II study of tepotinib in NSCLC patients with METex14 mutations. Presentation at 2019 ASCO Annual Meeting; abstract 9005.
2. Wolf J, et al. Capmatinib (INC280) in METΔex14-mutated advanced non-small cell lung cancer. (NSCLC): Efficacy data from the phase II GEOMETRY mono-1 study. Presentation at 2019 ASCO Annual Meeting; abstract 9004.

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touchCONGRESS Expert Interviews

What is the emerging clinical landscape in MET exon 14 skipping positive NSCLC?

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Introduction

Hear renowned clinical specialists in lung cancer give their opinions on the latest developments in NSCLC with MET exon 14 skipping alterations with our touchCONGRESS Expert Interviews filmed at the European Society for Medical Oncology (ESMO) Annual Meeting in Barcelona, 27 September–1 October 2019.

Issues around MET inhibitor treatment and liquid biopsy for the identification of MET alterations are considered from both global and regional perspectives.

This activity is intended for oncologists and healthcare professionals outside the USA.

These touchCONGRESS Expert Interviews were recorded in October 2019.

Learning Objectives

After watching these touchCONGRESS Expert Interviews, you should be able to:

  • Recognize unmet needs for patients with METex14+ NSCLC, including practical considerations for all members of the multidisciplinary team in order to achieve prompt and effective mutation testing and corresponding treatment initiation
  • Describe the evolving therapeutic landscape and emerging clinical trial data in METex14+ NSCLC and the potential impact in your own country
  • Identify eligibility criteria and patients appropriate for referral to ongoing clinical trials investigating METex14+ NSCLC