Abou-Alfa GK, Meyer T, Cheng A-L, et al. Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med. 2018;379:54-63.
Boku N, Ryu MH, Oh D-Y, et al. Nivolumab plus chemotherapy versus chemotherapy alone in patients with previously untreated advanced or recurrent gastric/gastroesophageal junction (G/GEJ) cancer: ATTRACTION-4 (ONO-4538-37) study. Presented at: 2020 ESMO Congress Virtual; 2020. Abstract LBA7.
Chin K, Kato K, Cho BC, et al. Three-year follow-up of ATTRACTION-3: a phase 3 study of nivolumab in patients with advanced esophageal squamous cell carcinoma that is refractory or intolerant to previous chemotherapy. Presented at: ASCO® Gastrointestinal Cancers Symposium Virtual; January 15-17, 2021. Abstract 204.
ClinicalTrials.gov. An investigational immuno-therapy study of nivolumab or placebo in patients with resected esophageal or gastroesophageal junction cancer (CheckMate 577). NCT02743494. Updated September 1, 2020. Accessed February 20, 2021. https://clinicaltrials.gov/ct2/show/NCT02743494
ClinicalTrials.gov. A study of nivolumab in combination with ipilimumab in participants with advanced hepatocellular carcinoma (CheckMate 9DW). NCT04039607. Updated November 9, 2020. Accessed February 20, 2021. https://clinicaltrials.gov/ct2/show/NCT04039607
ClinicalTrials.gov. Combination of regorafenib and nivolumab in unresectable hepatocellular carcinoma (REBONATE). NCT04310709. Updated June 18, 2020. Accessed February 20, 2021. https://clinicaltrials.gov/ct2/show/NCT04310709
ClinicalTrials.gov. Safety and efficacy of lenvatinib (E7080-MK-7902) in combination with pembrolizumab (MK-3475) versus lenvatinib as first-line therapy in participants with advanced hepatocellular carcinoma (MK-7902-002/E7080-G000-311/LEAP-002). NCT03713593. Updated April 1, 2020. Accessed February 20, 2021. https://clinicaltrials.gov/ct2/show/NCT03713593
ClinicalTrials.gov. Study of cabozantinib in combination with atezolizumab versus sorafenib in subjects with advanced HCC who have not received previous systemic anticancer therapy (COSMIC-312). NCT03755791. Updated February 2, 2021. Accessed February 20, 2021. https://clinicaltrials.gov/ct2/show/NCT03755791
ClinicalTrials.gov. Study of durvalumab and tremelimumab as first-line treatment in patients with advanced hepatocellular carcinoma (HIMALAYA). NCT03298451. Updated February 17, 2021. Accessed February 20, 2021. https://clinicaltrials.gov/ct2/show/NCT03298451
Doi T, Piha-Paul SA, Jalal SI, et al. Safety and antitumor activity of the anti–programmed death-1 antibody pembrolizumab in patients with advanced esophageal carcinoma. J Clin Oncol. 2018;36:61-67.
El-Khoueiry AB, Sangro B, You T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017;389:2492-2502.
El-Khoueiry AB, Yau T, Kang Y-K, et al. Nivolumab plus ipilimumab combination therapy in patients with advanced hepatocellular carcinoma: long-term results from CheckMate 040. Presented at: Gastrointestinal Cancers Symposium Virtual; January 15-17, 2021; Abstract 269.
Finn RS, Ikeda M, Zhu AX. Phase Ib study of lenvatinib plus pembrolizumab in patients with unresectable hepatocellular carcinoma. J Clin Oncol. 2020;38:2960-2970.
Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020;382:1894-1905.
Finn RS, Qin S, Ikeda M, et al. IMbrave150: updated overall survival data from a global, randomized, open-label Phase III study of atezolizumab + bevacizumab vs sorafenib in patients with unresectable hepatocellular carcinoma. Presented at: Gastrointestinal Cancers Symposium Virtual; January 15-17, 2021; Abstract 267.
Finn RS, Ryoo B-Y, Merle P, et al. Pembrolizumab as second-line therapy in patients with advanced hepatocellular carcinoma in KEYNOTE-240: A randomized, double-blind, phase III trial. J Clin Oncol. 2020;38:193-202.
Gordan JD, Kennedy EB, Abou-Alfa GK, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO® guideline. J Clin Oncol. 2020;38:4317-4345.
Huang J, Xu J, Chen Y, et al. Camrelizumab versus investigator’s choice of chemotherapy as second-line therapy for advanced or metastatic oesophageal squamous cell carcinoma (ESCORT): a multicentre, randomized, open-label, phase 3 study. Lancet Oncol. 2020;21:832-842.
Kato K, Cho BC, Takahashi M, et al. Nivolumab versus chemotherapy in patients with advanced, oesophageal squamous cell carcinoma refractory or intolerant to previous chemotherapy (ATTRACTION-3): a multicentre, randomized, open-label, phase 3 trial. Lancet Oncol. 2019;20:1506-1517.
Kato K, Sun J, Shah MA, et al. Pembrolizumab plus chemotherapy versus chemotherapy as first-line therapy in patients with advanced esophageal cancer: the phase 3 KEYNOTE-590 study. Presented at: ESMO Congress Virtual; 2020. Abstract LBA8.
Kelley RK, Negro A, Chen C, et al. Low immunogenicity and favorable safety seen with novel regimen of tremelimumab (T) plus durvalumab (D) in patients with unresectable hepatocellular carcinoma (uHCC). Presented at: ESCO Immuno-Oncology Virtual Congress 2020; Poster 32P.
Kelley RK, Oliver JW, Hazra S, et al. Cabozantinib in combination with atezolizumab versus sorafenib in treatment-naive advanced hepatocellular carcinoma: COSMIC-32 Phase III study. Future Oncol. 2020;16:1525-1536.
Kelley RK, Sangro B, Harris W, et al. Efficacy, tolerability, and biologic activity of a novel regimen of tremelimumab in combination with durvalumab for patients with advanced hepatocellular carcinoma. Presented at: 2020 American Society of Clinical Oncology Annual Meeting Virtual; May 29-31, 2020; Abstract 4508.
Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal gastroesophageal junction cancer following neoadjuvant chemoradiation therapy: final results of the CheckMate 577 study. Presented at: ESMO Congress Virtual; 2020. Abstract LBA9.
KEYTRUDA® (pembrolizumab) [prescribing information]. Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc. Approved 2014. Updated November 2020. Accessed February 20, 2021.
Kojima T, Shah MA, Muro K, et al. Randomized phase III KEYNOTE-181 study of pembrolizumab versus chemotherapy in advanced esophageal cancer. J Clin Oncol. 2020;38:4138-4148.
Kudo M, Ikeda M, Motomura K, et al. A phase 1b study of lenvatinib plus nivolumab in patients with unresectable hepatocellular carcinoma (study 117). Presented at: American Society of Clinical Oncology Gastrointestinal Cancers Symposium; January 23-25, 2020; San Francisco, CA. Abstract 513.
Mansoor W, Kulkarni AS, Kato K, et al. Health-related quality of life of pembrolizumab plus chemotherapy versus chemotherapy as first-line therapy in patients with advanced esophageal cancer: the phase 3 KEYNOTE-590 study. Presented at: Gastrointestinal Cancers Symposium Virtual; January 15-17, 2021. Abstract 168.
Merle P, Edeline J, Bouattour M, et al. Pembrolizumab (pembro) vs placebo (pbo) in patients (pts) with advanced hepatocellular carcinoma (aHCC) previously treated with sorafenib: updated data from the randomized, phase III KEYNOTE-240 study. Presented at: Gastrointestinal Cancers Symposium Virtual; January 15-17, 2021; Abstract 268.
Moehler M, Shitara K, Garrido M, et al. Nivolumab plus chemotherapy versus chemotherapy as first-line treatment for advanced gastric cancer/gastroesophageal junction cancer/esophageal adenocarcinoma: first results of the CheckMate 649 study. Presented at: 2020 ESMO Congress Virtual; 2020. Abstract LBA6.
Muro K, Chung HC, Shankaran V, et al. Pembrolizumab for patients with PD-1–positive advanced gastric cancer (KEYNOTE-012): a multcentre, open-label, phase 1b trial. Lancet Oncol. 2016;17:717-726.
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CME / ABIM MOC

Essential Updates in GI Immunotherapy: HCC and Esophageal Cancers

Authors: Lipika Goyal, MD; Samuel Klempner, MD
CME / ABIM MOC Released: 3/19/2021
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 3/19/2022

Target Audience and Goal Statement

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

The goal of this activity is to improve oncologists’ ability to integrate immune checkpoint inhibitors into the care of unresectable hepatocellular carcinoma (HCC) and esophageal cancer.

Upon completion of this activity, participants will:

Have increased knowledge regarding the
- Role of immunotherapy in esophageal cancer
- Clinical data for immunotherapy use in unresectable HCC
Have greater competence related to the
- Identification of appropriate candidates for treatment with immune checkpoint inhibitors in patients with HCC
- Integration of immune checkpoint inhibitors for patients with esophageal cancer

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

Lipika Goyal, MD

Assistant Professor of Medicine
Harvard Medical School
Gastrointestinal Medical Oncologist
Massachusetts General Hospital Cancer Center
Boston, Massachusetts

Disclosures

Disclosure: Lipika Goyal, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Agios Pharmaceuticals; Alentis Therapeutics AG; AstraZeneca; DSMC; Exelexis; Incyte Corporation; Sirtex Medical Ltd; Taiho Oncology Inc
Received grants for clinical research from: Adaptimmune; Agios; Bayer; Bristol Myers Squibb; Genentech; Incyte; Leap Therapeutics; Loxo Oncology; Macrogenetics; Merck; Novartis; Nucana; QED; Taiho Oncology

Samuel Klempner, MD

Assistant Professor
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts

Disclosures

Disclosure: Samuel Klempner, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: BMS; Eli Lilly; Merck; Natera; Pieris
Owns stock, stock options, or bonds from: Turning Point Therapeutics

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

Davecia Ragoonath-Cameron, MS

Medical Education Director, Medscape, LLC

Disclosures

Disclosure: Davecia Ragoonath-Cameron, MS, has disclosed no relevant financial relationships.

Jason Luis Quinones, PhD

Scientific Content Manager, Medscape, LLC

Disclosures

Disclosure: Jason Luis Quinones, PhD, has disclosed no relevant financial relationships.

Society for Immunotherapy of Cancer

Asha Karippot, MD

Medical Oncologist and Hematologist
Cancer Treatment Centers of America

Disclosures

Disclosure: Asha Karippot, MD, has disclosed no relevant financial relationships.

Stephanie Burmeister, MLIS

Online Education Program Manager

Disclosures

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

Mary Dean, JD

Associate 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

Associate Director of Online 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

Director of Education

Disclosures

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

Tara Withington, CAE

Executive Director

Disclosures

Disclosure: Tara Withington, CAE, has disclosed no relevant financial relationships.

Content Reviewer

Robert Morris, PharmD

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: ViiV Healthcare
Owns stock, stock options, or bonds from: GlaxoSmithKline

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.

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Developed through a partnership between Medscape and Society for Immunotherapy of Cancer.

In support of improving patient care, 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 0.75 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 0.75 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.

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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 75% on the post-test.

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From Medscape Education Oncology

CME / ABIM MOC

Essential Updates in GI Immunotherapy: HCC and Esophageal Cancers

Authors: Lipika Goyal, MD; Samuel Klempner, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC Released: 3/19/2021

Valid for credit through: 3/19/2022

processing....

Editor’s Note: On March 22, 2021, the Food and Drug Administration approved pembrolizumab in combination with platinum and fluoropyrimidine-based chemotherapy for patients with metastatic or locally advanced esophageal or gastroesophageal (tumors with epicenter 1 to 5 centimeters above the gastroesophageal junction) carcinoma who are not candidates for surgical resection or definitive chemoradiation.

Contents of This CME Activity

All sections of this activity are required for credit.

Essential Updates in GI Immunotherapy: HCC and Esophageal Cancers

Join Dr Goyal for a short discussion on the evolving landscape of immunotherapies for the treatment of advanced/metastatic HCC.
Lipika Goyal, MD

Unresectable HCC: Treatment With ICIs to Come

Dr Goyal provides an overview of new and emerging treatment regimens for the management of patients with unresectable HCC.
Lipika Goyal, MD

Current Treatment of Metastatic Esophageal Cancer With ICIs

Dr Klempner reviews recent approvals and key clinical data supporting the use of ICIs in the metastatic esophageal cancer setting.
Samuel Klempner, MD

Esophageal Carcinoma Treatment: Ongoing Investigations With Immune Checkpoint Inhibitors

Join Dr Klempner for a discussion on key emerging clinical trials investigating ICI regimens that are likely to impact clinical practice in the near future.
Samuel Klempner, MD

Educational Impact Challenge

The goal of this activity is to improve oncologists’ ability to integrate immune checkpoint inhibitors into the care of unresectable hepatocellular carcinoma (HCC) and esophageal cancer.

Before you begin this activity, please assess your clinical knowledge by completing this brief survey. Answering these questions again after the activity will allow you to see what you learned and to compare your answers with those of your peers.

Page 1 of 7

CME / ABIM MOC Information Download Slides

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The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been approved by the US Food and Drug Administration, off-label uses of approved products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

References

Faculty and Disclosures

Faculty

Lipika Goyal, MD

Samuel Klempner, MD

Steering Committee

Jeffrey Weber, MD, PhD

Ramaswamy Govindan, MD

Lipika Goyal, MD, MPhil

Rita Nanda, MD

Brian Rini, MD

Jared Weiss, MD

Editors

Davecia Ragoonath-Cameron, MS

Jason Luis Quinones, PhD

Society for Immunotherapy of Cancer

Asha Karippot, MD

Stephanie Burmeister, MLIS

Mary Dean, JD

Jacqueline Gearheart

Claire Leischer, MS

Edwin O'Sullivan, PhD

Alicia Schuessler, CAE

Tara Withington, CAE

Content Reviewer

Robert Morris, PharmD

Peer Reviewer

CME / ABIM MOC

Essential Updates in GI Immunotherapy: HCC and Esophageal Cancers

Target Audience and Goal Statement

Disclosures

Faculty

Lipika Goyal, MD

Samuel Klempner, MD

Steering Committee

Jeffrey Weber, MD, PhD

Ramaswamy Govindan, MD

Lipika Goyal, MD, MPhil

Rita Nanda, MD

Brian Rini, MD

Jared Weiss, MD

Editors

Davecia Ragoonath-Cameron, MS

Jason Luis Quinones, PhD

Society for Immunotherapy of Cancer

Asha Karippot, MD

Stephanie Burmeister, MLIS

Mary Dean, JD

Jacqueline Gearheart

Claire Leischer, MS

Edwin O'Sullivan, PhD

Alicia Schuessler, CAE

Tara Withington, CAE

Content Reviewer

Robert Morris, PharmD

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Essential Updates in GI Immunotherapy: HCC and Esophageal Cancers

Contents of This CME Activity

Essential Updates in GI Immunotherapy: HCC and Esophageal Cancers

Unresectable HCC: Treatment With ICIs to Come

Current Treatment of Metastatic Esophageal Cancer With ICIs

Esophageal Carcinoma Treatment: Ongoing Investigations With Immune Checkpoint Inhibitors

Educational Impact Challenge