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CME / ABIM MOC

Steps and Considerations to Optimizing Management of Recurrent/Metastatic Head and Neck Cancer

  • Authors: Siddharth Sheth, DO, MPH
  • CME / ABIM MOC Released: 1/25/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/25/2022
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Target Audience and Goal Statement

This activity is intended for oncologists, pathologists, and surgeons.

The goal of this activity is to improve clinicians' ability to manage patients with recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC).

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Clinical trial design and data from recent trials for recurrent or metastatic HNSCC
  • Have greater competence related to
    • Identifying patient and tumor characteristics that can help guide treatment selection in patients with recurrent or metastatic HNSCC across the disease spectrum
    • Developing an evidence-based treatment plan for a patient with recurrent or metastatic HNSCC across the disease spectrum
    • Recognizing and mitigating treatment- and immune-related adverse events (irAEs)


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Faculty

  • Siddharth Sheth, DO, MPH

    Assistant Professor of Medicine
    Division of Medical Oncology
    University of North Carolina-Chapel Hill
    Lineberger Comprehensive Cancer Center
    Chapel Hill, North Carolina

    Disclosures

    Disclosure: Siddharth Sheth, DO, MPH, has disclosed the following relevant financial relationships:
    Received grants for clinical research from: AstraZeneca; Inovio; Merck

Steering Committee

  • Jeffrey Weber, MD, PhD

    Deputy Director
    Laura and Isaac Perlmutter Cancer Center
    Professor of Medicine
    NYU Grossman School of Medicine
    New York, New York

    Disclosures

    Disclosure: Jeffrey Weber, MD, PhD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: AstraZeneca; Bristol Myers Squibb Company; Celldex; CV6; CytomX; Genentech; GlaxoSmithKline; Incyte; Merck; Novartis; Pfizer; Protean
    Owns stock, stock options, or bonds from: Biond; CytomX; Immunomax
    Other: Named on a PD-1 biomarker patent by Biodesix; Named on a CTLA-4 biomarker patent by Moffitt Cancer Center

  • Ramaswamy Govindan, MD

    Professor of Medicine
    Division of Medical Oncology
    Washington University School of Medicine
    Co-Director, Section of Medical Oncology
    Siteman Cancer Center
    Barnes-Jewish Hospital
    St Louis, Missouri

    Disclosures

    Disclosure: Ramaswamy Govindan, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Achilles; GenePlus; Horizon Pharma (Spouse)

  • Lipika Goyal, MD, MPhil

    Assistant Professor in Medicine
    Harvard Medical School
    Lead of the Liver Cancer Research Program
    Massachusetts General Hospital Cancer Center
    Boston, Massachusetts

    Disclosures

    Disclosure: Lipika Goyal, MD, MPhil, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Agios; Alentis Pharma; AstraZeneca; Debiopharm; Incyte; QED; SIRTEX; Taiho

  • Rita Nanda, MD

    Associate Professor of Medicine
    Director, Breast Oncology Program
    The University of Chicago Medicine
    Chicago, Illinois

    Disclosures

    Disclosure: Rita Nanda, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Clovis; G1 Therapeutics; Genentech; Immunomedics; MacroGenics; Merck; Pfizer; Seattle Genetics
    Received grants for clinical research from: AstraZeneca; Celgene; Corcept Therapeutics; Genentech/Roche; Immunomedics; Merck; OBI Pharm, Inc.; Odonate Therapeutics; Pfizer; Seattle Genetics
    Other: G1 Therapeutics (DSMB)

  • Brian Rini, MD

    Ingram Professor of Medicine
    Chief of Clinical Trials
    Vanderbilt-Ingram Cancer Center
    Nashville, Tennessee

    Disclosures

    Disclosure: Brian Rini, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: 3dMedicines; Alkermes; Aravive; Arrowhead; Aveo; BMS; Compugen; Corvus; GlaxoSmithKline; Genentech/Roche; Merck; Pfizer; Shionogi; Surface Oncology; Synthorx
    Received grants for clinical research from: AstraZeneca; Aveo; BMS; Exelixis; Genentech/Roche; Merck; Pfizer
    Owns stock, stock options, or bonds from: PTC Therapeutics

  • Jared Weiss, MD

    Associate Professor of Medicine
    Lineberger Comprehensive Cancer Center
    Section Chief
    Thoracic and Head and Neck Oncology
    University of North Carolina, Chapel Hill
    Chapel Hill, North Carolina

    Disclosures

    Disclosure: Jared Weiss, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: AbbVie; AstraZeneca; Azitra; Eli Lilly; EMD Serono; G1; Jazz; Jounce; Pfizer; Saatchi
    Received grants for clinical research from: AstraZeneca; Celgene; Immunicum; Loxo/Lilly; Merck
    Owns stock, stock options, or bonds from: Nektar; Vesselon

Editors

  • Charlotte Warren

    Senior Director, Content Development, Medscape, LLC

    Disclosures

    Disclosure: Charlotte Warren, has disclosed no relevant financial relationships.

  • Tristin Abair, PhD

    Senior Medical Writer, Medscape, LLC 

    Disclosures

    Disclosure: Tristin Abair, PhD, has disclosed no relevant financial relationships. 

Course Director

  • Amanda Psyrri, MD

    Associate Professor of Medical Oncology
    University of Athens
    Athens, Greece

    Disclosures

    Disclosure: Amanda Psyrri, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: BMS; AstraZeneca; MSD; Merck Serono; Pfizer; eTheRNA; Ipsen
    Served as a speaker or a member of a speakers bureau for: MSD; BMS
    Received grants for clinical research from: BMS; MSD; KURA; Pfizer; Merck Serono; Amgen; Roche; Bayer; Rakuten

  • Stephanie Burmeister, MLIS

    Online Education Program Manager

    Disclosures

    Disclosure: Stephanie Burmeister, MLIS, has disclosed no relevant financial relationships.

  • Mary Dean, JD

    Executive Director

    Disclosures

    Disclosure: Mary Dean, JD, has disclosed no relevant financial relationships.

  • Jacqueline Gearheart

    Program Manager

    Disclosures

    Disclosure: Jacqueline Gearhart has disclosed no relevant financial relationships.

  • Claire Leischer, MS

    Director of Education

    Disclosures

    Disclosure: Claire Leischer, MS, has disclosed no relevant financial relationships.

  • Edwin O'Sullivan, PhD

    Senior Manager of Online Education

    Disclosures

    Disclosure: Edwin O'Sullivan, PhD, has disclosed the following relevant financial relationships:
    Owns stock, stock options, or bonds from: Aveo Oncology

  • Alicia Schuessler, CAE

    Associate Executive Director

    Disclosures

    Disclosure: Alicia Schuessler, CAE, has disclosed no relevant financial relationships.

CME Reviewer

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.


Accreditation Statements



In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Society for Immunotherapy of Cancer. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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CME / ABIM MOC

Steps and Considerations to Optimizing Management of Recurrent/Metastatic Head and Neck Cancer

Authors: Siddharth Sheth, DO, MPHFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC Released: 1/25/2021

Valid for credit through: 1/25/2022

processing....

The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

Case 1: Patient History and Presentation

Tabitha is a 44-year-old pediatrician who presented with a T4N0 right lateral tongue lesion. She underwent primary surgery. Surgical pathology showed a human papilloma virus (HPV)-negative squamous cell carcinoma (SCC) with positive surgical margins, invasion of the mandible, and perineural invasion. She received adjuvant therapy with concurrent radiation therapy and cisplatin.

She now presents 7 months after completion of adjuvant therapy with sharp pain while eating and occasional dysphagia with solid foods. She denies pain while swallowing or any other new symptoms. She continues to experience dry mouth from her radiation therapy. She tells you she recently lost 10 lb, but she started taking an aerobics class at the gym with her best friend and assumed that was the cause of her weight loss. Tabitha's initial exam and imaging are summarized in Table 1.

Table 1. Summary of Tabitha's Initial Workup

Demographics

  • 44 years old, female
  • Height: 5'4''; Weight: 145 lb; BMI: 24.9

Personal and family medical history

  • Healthy, active
  • Non-smoker; social drinker
  • Medical history includes seasonal allergies and acid reflux
  • Current medications include pantoprazole once a day and fexofenadine hydrochloride as needed
  • Mother had breast cancer at age 68. No other family history of cancer

Physical exam

  • ECOG PS 0
  • Vitals: HR 85, BP 115/82, RR 16 breaths/min, T 37.1
  • Well appearing, no acute distress
  • Cracked lips, red tongue, dry throat
  • Erythema and swelling visible at the initial tumor site
  • Lungs clear to auscultation

Imaging

  • CT shows infiltrative mass with perineural invasion and invasion of internal carotid artery suggestive of local recurrence
  • PET/CT negative for distant metastases
BMI = body mass index; BP = blood pressure; CT = computed tomography; ECOG = Eastern Cooperative Oncology Group; HR = heart rate; PET = positron emission tomography; PS = performance status; RR = respiration rate.

Tabitha was evaluated by a head and neck multidisciplinary team that included otolaryngology, radiation oncology, and medical oncology.

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