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Expert Practice Article - Evolving Therapeutic Concepts in Glioblastoma: Augmenting Chemoradiation
The standard of care for patients with newly diagnosed glioblastoma is radiation therapy and adjuvant temozolomide. Strategies to optimize this combination are being actively studied, and treatment recommendations have been offered to maximize treatment success. Unfortunately, the prognosis for many patients remains poor—especially for those in whom disease has recurred. The poor clinical outcome for patients with glioblastoma necessitates an examination of the underlying mechanisms of disease progression and a discussion of new therapies and their prospects of improving patient survival.
In this Expert Practice Article, Jan C. Buckner, MD, at the Mayo Clinic in Rochester, Minnesota reviews current data on targeted agents in development for the treatment of glioblastoma and provides insights on the practical considerations of using targeted agents to treat glioblastoma.
Sponsored by
Support for this activity has been provided through educational grants from Genentech and Millennium: The Takeda Oncology Company.
Hardware/Software Requirements
- Javascript-enabled browser
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Active Internet connection
Activity Overview
Currently, the standard of care for patients with newly diagnosed glioblastoma is radiation therapy and adjuvant temozolomide. Strategies to optimize this combination are being actively studied, and treatment recommendations have been offered to maximize treatment success. Unfortunately, the prognosis for many patients remains poor—especially for those in whom disease has recurred. The poor clinical outcome for patients with glioblastoma necessitates an examination of the underlying mechanisms of disease progression and a discussion of new therapies and their prospects of improving patient survival.
Target Audience
This activity has been designed to meet the educational needs of radiation oncologists, neuro-oncologists, and other health care professionals involved in the care and treatment of patients with brain cancer.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Assess the clinical evidence for the use of targeted agents in combination with chemoradiation
- List the advantages and limitations of combining chemoradiation with targeted agents
- Describe the physiologic and neuroimaging changes that targeted agents induce in patients with glioblastoma
Faculty
| Jan C. Buckner, MD - View Bio Professor of Oncology Chair, Division of Medical Oncology Mayo Clinic Rochester, Minnesota |
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Disclosure
In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control.
Relationship information appears below:
Jan C. Buckner, MD, has disclosed the following relevant financial relationships:
| Consultant | EMD Serono |
Dr. Buckner discusses the unlabeled or investigational use of a commercial product.
Curatio CME Institute
Thomas Finnegan, PhD, Medical Writer, has disclosed no relevant financial relationships.
Denise C. LaTemple, PhD, Vice President, Scientific Services, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Managing Editor, has disclosed no relevant financial relationships.
Derek Warnick, CME Director, has disclosed no relevant financial relationships.
Accreditation Statement
Curatio CME Institute is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
Curatio CME Institute designates this educational activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period September 2009 to September 30, 2010, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the postsurvey, and (4) complete the activity evaluation form. Participants will be able to download a certificate upon completion of the postsurvey. Please e-mail any questions to cmeinfo@curatiocme.com.
Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.
Disclaimer
The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.
Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute, Genentech, and Millennium: The Takeda Oncology Company do not recommend the use of any agent outside the labeled indications.
The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute, Genentech, or Millennium: The Takeda Oncology Company. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
| Generic Name | Trade Name | Approved Use (if any) | Unapproved/Investigational Use |
| Bevacizumab | Avastin® | As single agent, treatment of glioblastoma multiforme (GBM) with progressive disease following prior therapy | In combination with temozolomide, with or without radiation therapy, for newly diagnosed or recurrent GBM |
| Bortezomib | Velcade® | Treatment of patients with multiple myeloma; treatment of patients with mantle cell lymphoma who have received at least 1 prior therapy | In combination with temozolomide and radiation therapy for newly diagnosed or recurrent GBM |
| Cediranib | NA | NA | Treatment of GBM |
| Cetuximab | Erbitux® | Head and neck cancer; alone or in combination with irinotecan for colorectal cancer | In combination with bevacizumab and irinotecan for GBM |
| Cilengitide | NA | NA | Treatment of GBM |
| Erlotinib | Tarceva® | Locally advanced or metastatic non–small cell lung cancer (NSCLC); locally advanced, unresectable, or metastatic pancreatic cancer, in combination with gemcitabine | Alone or in combination with temozolomide for the treatment of recurrent or newly diagnosed GBM |
| Everolimus | Afinitor® | Treatment of patients with advanced renal cell carcinoma (RCC) after failure of treatment with sunitinib or sorafenib | |
| Gefitinib | Iressa® | Locally advanced or metastatic NSCLC | Alone or in combination with temozolomide for the treatment of recurrent or newly diagnosed GBM |
| Irinotecan | Camptosar | In combination with 5-fluorouracil and leucovorin for patients with metastatic carcinoma of the colon or rectum; metastatic carcinoma of the colon or rectum whose disease has recurred or progressed following initial fluorouracil-based therapy | In combination with bevacizumab and cetuximab for GBM |
| Sirolimus | Rapamune® | Prophylaxis of organ rejection in patients aged ≥13 years receiving renal transplants | Treatment of GBM |
| Sorafenib | Nexavar® | Unresectable hepatocellular carcinoma; advanced RCC | In combination with temozolomide for the treatment of newly diagnosed or recurrent GBM |
| Sunitinib | Sutent® | Gastrointestinal stromal tumor after disease progression on or intolerance to imatinib mesylate; advanced RCC | In combination with temozolomide and radiation therapy for recurrent GBM |
| Temozolomide | Temodar® | Treatment of adult patients with newly diagnosed GBM concomitantly with radiotherapy and then as maintenance treatment; treatment of adult patients with refractory anaplastic astrocytoma | In combination with bevacizumab, bortezomib, erlotinib, gefitinib, sorafenib, sunitinib, or temsirolimus for the treatment of GBM |
| Temsirolimus | Torisel® | Treatment of advanced RCC | Alone or in combination with temozolomide for the treatment of recurrent or newly diagnosed GBM |
| Vandetanib | NA | NA | Treatment of GBM |
| Vorinostat | Zolinza® | Treatment of cutaneous manifestations in patients with cutaneous T-cell lymphoma (CTCL) who have progressive, persistent, or recurrent disease on or following two systemic therapies | Treatment of recurrent GBM |
| XL184 | NA | NA | Treatment of GBM |
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