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Integrating Tyrosine Kinase Inhibitors in Colorectal Cancer Treatment Algorithms:
Considerations for NTRK Gene Fusion Targeted Therapy

Presented by the Johns Hopkins University School of Medicine
and the Institute for Johns Hopkins Nursing.

Supported by an educational grant from Bayer

OVERVIEW
In human cancers, gene fusions involving neurotrophic tyrosine receptor kinases (NTRKs) are known drivers of a wide variety of adult and pediatric solid tumors. They are most frequently observed in rare tumors and are rare in more common tumor types. In patients with metastatic colorectal cancer (mCRC), they occur in approximately 1% of cases. When NTRK fusions are identified, they enable the use of tropomyosin receptor kinase inhibitors (TRKIs), which have emerged as a highly effective treatments in patients with tumors harboring these rearrangements, making identification of NTRK fusions critical. Using a case-based approach, this activity will explore the diagnosis and treatment of a hypothetical patient with mCRC found to harbor an NTRK fusion. It will provide an overview of the latest genetic testing recommendations, a review of safety and efficacy data for new and emerging TRKIs, and examine TRKI-related toxicities and how to best manage them.

GOAL
The goal of this activity is to increase understanding of NTRK fusions, including how to optimize genetic testing, when and how to implement treatment with a TRKI, and how to identify and effectively manage TRKI-related toxicities.

WHO SHOULD ATTEND
This activity is intended for oncologists and healthcare providers (physician assistants, nurse practitioners, pharmacists) involved in the care and management of patients with colorectal cancer. No prerequisites required.

OBJECTIVES
After participating in this activity, the participant will demonstrate the ability to:
  • ASSESS the efficacy and safety of new and emerging TKIs in CRC treatment algorithms, incorporating genomic-driven TKI therapy.
  • DESCRIBE the clinical relevance of NTRK fusion genetic testing on treatment-decision-making in CRC and the rationale for TRK inhibitor therapy.
  • IMPLEMENT sstrategies to recognize and manage TKI-related AEs and toxicities and complications in a/m CRC patients.
The Johns Hopkins School of Medicine and the Institute for Johns Hopkins Nursing take responsibility for the content, quality, and scientific integrity of this CME/CNE activity.

CE INFORMATION
Accreditation Statements
accme_logoThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Credit Designation Statements
The Johns Hopkins University School of Medicine designates this enduring material internet activity for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This .5 contact hour educational activity is provided by the Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Statements will be awarded for this educational activity until January 21, 2020.

The estimated time to complete this activity: 30 minutes.

Release date: January 22, 2020     Expiration date: January 22, 2021

Policy on Presenter and Provider Disclosure
It is the policy of the Johns Hopkins School of Medicine and the Institute for Johns Hopkins Nursing that the presenter and provider globally disclose conflicts of interest. The Johns Hopkins School of Medicine OCME has established policies that will identify and resolve conflicts of interest prior to this educational activity. Detailed disclosure will be made prior to presentation of the education.

Full Disclosure Policy Affecting CME Activities
AAs a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME.
The following relationships have been reported for this activity:

Dr. Ettinger reports receiving a consulting fee from BeyondSpring Inc., Boehringer Ingelheim Vetmedica GmbH, Bristol-Myers Squib Company, Eli Lilly and Company, Guardant Health, Inc., Genentech, Inc., and sanofi-aventis

Dr Azad reports serving as a principal investigator for Agios, Inc., Array BioPharma Inc., Astex Pharmaceuticals, Bayer AG, Bristol-Myers Squibb Company, Celgene Corporation, Debiopharm, EMD Serono, Inc., Intensity Therapeutics, Inc., Merck & Co Inc, Syndax Pharmaceuticals, Inc., and Tanabe.


No one else in a position to control the content of this educational activity has disclosed a relevant financial interest or relationship with any commercial interest.

Note: Grants to investigators at the Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

Faculty
Johns Hopkins School of Medicine Chair, Planner, and Faculty Author
David S. Ettinger, MD

Alex Grass Professor of Oncology
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland

Faculty Authors
Nilofer Azad, MD
Associate Professor of Oncology
Johns Hopkins School of Medicine
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland

Christopher Jakubowski, MD
Johns Hopkins School of Medicine
Sidney Kimmel Comprehensive Cancer Center
Medical Oncology Fellow
Baltimore, Maryland

Nurse Planner
Rebecca Barshick, RN, MSN

Nurse Educator
The Institute for Johns Hopkins Nursing
Baltimore, Maryland

Nurse Reviewer
MiKaela Olsen, APRN-CNS, MS, AOCNS, FAAN

Oncology and Hematology Clinical Nurse Specialist
Ambulatory Oncology
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins Hospital
Baltimore, Maryland

Peer Reviewer
Daniel Suzman, MD

Department of Oncology
Sibley Memorial Hospital
Baltimore, Maryland

Non-Endorsement of Products
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

Confidentiality Disclaimer for CME Activity Participant
I certify that I am participating in this Johns Hopkins University School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am participating in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins University School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office at 410-955-2959 or e-mail cmenet@jhmi.edu.
Johns Hopkins School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03) (Updated 4/09 and 3/14)

HARDWARE & SOFTWARE REQUIREMENTS
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

THE INSTITUTE FOR JOHNS HOPKINS NURSING MISSION STATEMENT
The mission of the Institute for Johns Hopkins Nursing is to share the innovations of Johns Hopkins Nursing in practice, education, and research—locally, nationally, and globally. Our goal in continuing nursing education is to bring you activities that reflect the expertise and creativity of Johns Hopkins Nursing. Our service values are quality, integrity, flexibility, and personal attentiveness. We appreciate your thoughts and welcome your concerns—please feel free to e-mail us: IJHN@.jhmi.edu.

ACTIVITY INSTRUCTIONS
The following is an interactive case module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited preassessment, an interactive case study, and a CE post-assessment and evaluation. All 3 sections must be completed to receive CE credit. A certificate of participation will be available online immediately following successful completion of the activity.

Preassessment

Integrating Tyrosine Kinase Inhibitors in Colorectal Cancer Treatment Algorithms:
Considerations for NTRK Gene Fusion Targeted Therapy

Nilofer Azad, MD, and Christopher Jakubowski, MD

Postassessment and Evaluation
This activity was developed in collaboration with ASiM.


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