Naiyer Rizvi, MD, and Benny Weksler, MBA, MD, prepared useful Practice Aids pertaining to lung cancer for this CME/MOC/CE activity titled "The Evolving Role of Immunotherapy as a Component of Multimodal Therapy in Earlier Stages of Lung Cancer: Rationale, Current Evidence, Key Trials, and Implications for Multidisciplinary Care." For the full presentation, monograph, complete CME/MOC/CE information, and to apply for credit, please visit us at http://bit.ly/2KEjDL6. CME/MOC/CE credit will be available until December 5, 2019.
Naiyer Rizvi, MD, and Benny Weksler, MBA, MD, prepared useful Practice Aids pertaining to lung cancer for this CME/MOC/CE activity titled "The Evolving Role of Immunotherapy as a Component of Multimodal Therapy in Earlier Stages of Lung Cancer: Rationale, Current Evidence, Key Trials, and Implications for Multidisciplinary Care." For the full presentation, monograph, complete CME/MOC/CE information, and to apply for credit, please visit us at http://bit.ly/2KEjDL6. CME/MOC/CE credit will be available until December 5, 2019.
Precision Oncology: Combining Orthotopic-PDX Models and MRI, Moving Research ...Scintica Instrumentation
Certis Oncology Solutions is a precision oncology and translational science company. It works directly with cancer patients and their oncologists to help determine the best therapies for individuals, and also partners with pharmaceutical companies to help develop the next generation of anticancer therapies. Certis’s approach to studying drug efficacy is rooted in orthotopic patient-derived xenograft (O-PDX) models. Because tumors are internal to the animal, they usually cannot be measured by calipers. Certis overcomes this challenge by using magnetic resonance imaging (MRI), employing the Aspect M3 Compact MRI to generate high-resolution 3D anatomical images to monitor anti-cancer therapies in real-time.
Topics that were discussed in this webinar :
- Overview of precision oncology and testing platforms
- Comparison on subcutaneous and orthotopic in vivo models
- Imaging modalities for pre-clinical in vivo studies
- Applications of MRI in precision oncology and preclinical in vivo pharmacology studies
PET Imaging of Urothelial Bladder CancerBruce Fryer
PET Imaging of Urothelial Bladder Cancer: Addressing an Unmet Need
- This is a first in human study to image UBC by targeting VPAC receptors.
- Cu-64-TP3805 has high affinity for VPAC receptors.
- Cu-64-TP3805 has no urinary excretion.
- There were no AEs.
- Results to image UBC and its distant metastases are encouraging.
- Copper-64 has half life (t½ 12.7 hrs) long enough allowing to ship Cu-64-TP3805 to long distances, without excessive decay of Cu-64.
M. L. Thakur, PhD
FSNMMI, FNAI, FACNM, FICNM, FARR
Professor of Radiology, Radiation Oncology & Urology
Director, Laboratories of Radiopharmaceutical
Research and Molecular Imaging,
Thomas Jefferson University
Philadelphia, PA
High Through-Put DNA Methylation Analysis of Lung Cancer: Plasma cfDNA for Bi...Kate Barlow
• Technology pipeline for methylation biomarker
development
• High throughput DNA methylation-qPCR workflows
• Liquid biopsy – cfDNA methylation testing
Precision Oncology: Combining Orthotopic-PDX Models and MRI, Moving Research ...Scintica Instrumentation
Certis Oncology Solutions is a precision oncology and translational science company. It works directly with cancer patients and their oncologists to help determine the best therapies for individuals, and also partners with pharmaceutical companies to help develop the next generation of anticancer therapies. Certis’s approach to studying drug efficacy is rooted in orthotopic patient-derived xenograft (O-PDX) models. Because tumors are internal to the animal, they usually cannot be measured by calipers. Certis overcomes this challenge by using magnetic resonance imaging (MRI), employing the Aspect M3 Compact MRI to generate high-resolution 3D anatomical images to monitor anti-cancer therapies in real-time.
Topics that were discussed in this webinar :
- Overview of precision oncology and testing platforms
- Comparison on subcutaneous and orthotopic in vivo models
- Imaging modalities for pre-clinical in vivo studies
- Applications of MRI in precision oncology and preclinical in vivo pharmacology studies
PET Imaging of Urothelial Bladder CancerBruce Fryer
PET Imaging of Urothelial Bladder Cancer: Addressing an Unmet Need
- This is a first in human study to image UBC by targeting VPAC receptors.
- Cu-64-TP3805 has high affinity for VPAC receptors.
- Cu-64-TP3805 has no urinary excretion.
- There were no AEs.
- Results to image UBC and its distant metastases are encouraging.
- Copper-64 has half life (t½ 12.7 hrs) long enough allowing to ship Cu-64-TP3805 to long distances, without excessive decay of Cu-64.
M. L. Thakur, PhD
FSNMMI, FNAI, FACNM, FICNM, FARR
Professor of Radiology, Radiation Oncology & Urology
Director, Laboratories of Radiopharmaceutical
Research and Molecular Imaging,
Thomas Jefferson University
Philadelphia, PA
High Through-Put DNA Methylation Analysis of Lung Cancer: Plasma cfDNA for Bi...Kate Barlow
• Technology pipeline for methylation biomarker
development
• High throughput DNA methylation-qPCR workflows
• Liquid biopsy – cfDNA methylation testing
CCSN welcomes back Helene Hutchings to discuss anal and colorectal cancer in this educational webinar. Helene will be discussing the symptoms & risk factors of these cancers, as well as treatment options that are available. She will also discuss prevention of anal and colorectal cancers and the benefits of peer-to-peer support groups.
There will be a Q&A session following the webinar.
About the presenter:
Helene Hutchings is the Founder/CEO of Anal Cancer-A Bum Rap as well as a member of IANS (International Anal Neoplasia Society). Helene's advocacy work extends beyond Canada as she is an international advocate for Anal Cancer Awareness, Pelvic Radiation Disease Awareness, particularly as it relates to sexual function. More locally, she is continually advocating for AIN (Anal Intraepithelial Neoplasia) screening in Ottawa, Canada, the city where she lives. Helene is also a cancer survivor, having been discharged from the care of her Colorectal Surgeon in October 2013 and Radiation Oncologist in Sept 2014.
Pancreatic cancer is a devastating disease that affects thousands of people around the world, and India is no exception. However, in recent years, there have been significant advancements in pancreatic cancer treatment in India, offering new hope to patients and their families. From innovative surgical techniques to targeted therapies and personalized medicine, the journey of courage and healing for pancreatic cancer patients in India has come a long way.
Pancreatic cancer is a devastating disease that affects thousands of people around the world, and India is no exception. However, in recent years, there have been significant advancements in pancreatic cancer treatment in India, offering new hope to patients and their families.
Read More: https://gomedii.com/blogs/english/doctors-hospitals/pancreatic-cancer-treatment-in-india/
دي دردشة عن الColorectal Cancer
تنفع لمستوى طلبة الطب او اللي داخلين MRCS
لو شوفتوه مفيد ممكن نكمل و ندعو ناس تحضر الدردشة دي لايف..
اعملو شير لو شايفينه مفيد..
تقييمكو و رايكو مفيد جدا..
tفيديوالمحاضرة علي اليوتيوب
https://www.youtube.com/watch?v=npmaXS0e1nQ
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Exploring Novel Treatments for Rett Syndromei3 Health
This slide deck, led by Timothy John Feyma, MD, Pediatric Neurologist at Gilette Children’s Hospital, will explore novel treatments and quality-of-life improvement strategies for children and adults with Rett syndrome.
STATEMENT OF NEED
Rett syndrome is a rare, debilitating neurodevelopmental disorder almost always associated with a spontaneous mutation in the methyl-CpG-binding protein 2 (MECP2) gene on the X-chromosome. Affected individuals experience loss of purposeful hand skills, abnormalities in gait, loss of spoken language, and stereotypic hand movements, with more severe manifestations including seizures, autistic features, autonomic nervous system dysfunction, breathing abnormalities, sleep disturbances, and cardiac abnormalities. While therapies for Rett syndrome are being investigated in clinical trials and have demonstrated modest benefit, no curative or effective disease-modifying treatments currently exist (Petriti et al, 2023). Therefore, the multidisciplinary team is challenged with the optimal management of complex comorbidities that persist throughout patients’ lives. This activity chaired by Timothy John Feyma, MD, Pediatric Neurologist at Gilette Children’s Hospital, will explore novel treatments and quality-of-life improvement strategies for children and adults with Rett syndrome.
TARGET AUDIENCE
Pediatric and adult neurologists, pediatricians, internists, family physicians, child and adult psychiatrists, nurse practitioners, physician assistants, nurses, and other health care professionals involved in the treatment of children and adults with Rett syndrome.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Identify distinguishing features of Rett syndrome that can inform early and accurate diagnosis
Evaluate the safety, efficacy, and clinical utility of novel and emerging treatments for Rett syndrome in children and adults
Devise strategies to monitor and manage Rett syndrome symptoms in children and adults
Leveraging the Growing Arsenal of Adjuvant Therapies for Early-Stage NSCLCi3 Health
3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by, Dr. Helena A. Yu, Associate Attending Physician at Memorial Sloan Kettering Cancer Center, will provide insights into strategies for leveraging the growing arsenal of adjuvant therapies for early-stage non–small cell lung cancer (NSCLC), including treatment selection and adverse event management.
STATEMENT OF NEED
Lung cancer is the second most commonly diagnosed cancer and the leading cause of death for men and women worldwide. In the United States, non–small cell lung cancer (NSCLC) accounts for 81% of all lung cancer diagnoses (Cancer.net, 2023). Therapeutic options, survival rates, and outcomes for NSCLC are dramatically impacted by disease stage. For patients with early-stage disease, radical surgery is the mainstay of treatment; however, patients have a significant risk of relapse following surgery and local treatment. Numerous novel therapeutic approaches, including the use of molecular biomarkers and the development of targeted agents and immune checkpoint inhibitors, are under investigation for early-stage NSCLC, contributing to a growing arsenal of treatment options for this disease (Indini et al, 2020). In this visiting faculty meeting series chaired by Helena A. Yu, MD, Associate Attending Physician at Memorial Sloan Kettering Cancer Center, speakers will provide expert perspectives on diagnosis, identification of biomarkers, and efficacy and safety data of novel adjuvant therapies to improve survival outcomes for patients with early-stage NSCLC.
TARGET AUDIENCE
Medical oncologists, radiation oncologists, surgical oncologists, pulmonologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with non–small cell lung cancer (NSCLC).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Identify the correct tumor stage and appropriate management approach for NSCLC based on the latest evidence
Distinguish biomarkers for early-stage NSCLC that can inform individualized treatment strategies
Appraise efficacy and safety data of novel adjuvant therapies for patients with NSCLC as elucidated by recent clinical trials
Apply strategies to prevent and mitigate adverse events associated with novel adjuvant therapies for early-stage NSCLC
1 of 71
Download Now
Download to read offline
Leveraging the Growing Arsenal of Adjuvant
Therapies for Early-Stage NSCLC
Helena A. Yu, MD
Associate Attending Physician
Memorial Sloan Kettering Cancer Center
The video player is currently playing an ad.
Disclosures
Advisory board/panel: AbbVie, AstraZeneca, Black Diamond,
Blueprint, C4 Therapeutics, Cullinan, Daiichi Sankyo, Janssen, Taiho,
Takeda
Grants/research support: AstraZeneca, Black Diamond, Blueprint,
Cullinan, Daiichi Sankyo, Erasca, Janssen, Novartis, Pfize
Exploring Advances in the Early Diagnosis and Treatment of Alzheimer Disease ...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
In this slide deck, discover new insights into early diagnosis, emerging treatment modalities, and supportive care services for Alzheimer disease. An expert faculty member will discuss biological and clinical distinctions between mild cognitive impairment, dementia, and Alzheimer disease; methods for timely diagnosis; clinical trial data on novel monoclonal antibody therapies; prevention and management of side effects associated with monoclonal antibody therapies, including ARIA, and interdisciplinary support services for improving quality of life.
STATEMENT OF NEED
Alzheimer disease, the most common form of dementia among older adults, is a slowly progressive neurogenerative disease that affects approximately 6 million Americans aged 65 and older (Rajan et al, 2021). Symptoms of Alzheimer disease include memory loss, confusion, impulsive behavior, difficulty with language, mood and personality changes, hallucinations, and increased anxiety or aggression, with severe symptoms such as physical decline, difficulty swallowing, and inability to communicate developing as the disease progresses into its final stages (NIA, 2023). While new therapeutic agents have recently emerged to slow the progression of Alzheimer disease by targeting its underlying causes, the disease remains incurable, and the demands of day-to-day care place significant strain on both patients and their families and caregivers. Therefore, it is critical that clinicians remain up to date on early diagnosis, emerging treatment modalities, and supportive care services in order to provide optimal care for their patients. In this live webinar chaired by Nathaniel Chin, MD, Associate Professor of Medicine in the Division of Geriatrics and Gerontology at the University of Wisconsin-Madison, speakers will explore advances in the diagnosis and treatment of Alzheimer disease.
TARGET AUDIENCE
Geriatricians, neurologists, primary care physicians, psychiatrists, psychogeriatricians, nurse practitioners, physician assistants, nurses, and other health care professionals (HCPs) involved in the treatment of patients with Alzheimer disease (AD).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Utilize diagnostic methods that enable the timely identification of early Alzheimer disease (AD)
Evaluate the clinical utility of novel and emerging DMTs for the treatment of individual patients with early AD
Apply strategies to enhance interdisciplinary care for patients with early AD
Enhancing MRD Testing in Hematologic Malignancies: When Negativity is a Posit...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This expert CME-approved slide deck, presented by Noopur Raje, MD, Director of the Center for Multiple Myeloma at Massachusetts General Cancer Center, will explore the current and emerging roles of MRD testing in hematologic malignancies. She presents the ongoing questions and latest data regarding the clinical utility of MRD testing in prognosis and treatment.
STATEMENT OF NEED
Measurable residual disease (MRD) is defined as the persistence of cancer cells at levels below morphologic detection after treatment. For patients with hematologic malignancies, MRD testing is increasingly being used to predict disease progression, monitor disease status, and evaluate treatment options (Dekker et al, 2023). Questions about current and future roles of MRD testing abound, including validation of assays, such as next-generation sequencing, machine learning, and flow cytometry; standardization of collection methods and modalities; considerations for clinical trial design and statistical analyses; and improved understanding of the roles of MRD status and depth of response across hematologic malignancies (Dekker et al, 2023; Baines et al, 2023). It is critical for members of the multidisciplinary cancer care team to stay up-to-date on the latest data regarding the clinical utility of MRD testing in prognosis and treatment. In this CME-approved activity, Noopur Raje, MD, Director of the Center for Multiple Myeloma at Massachusetts General Cancer Center, will explore the current and emerging roles of MRD testing in hematologic malignancies.
TARGET AUDIENCE
Medical oncologists, hematologists, pathologists, and other health care professionals involved in the treatment of patients with hematologic malignancies.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Distinguish the advantages and limitations of current MRD detection methods
Evaluate consensus recommendations on indications for MRD testing in hematologic malignancies
Explain the current and potential roles of MRD status and depth of response as a biomarker in clinical trials
Describe mechanisms of drug resistance/loss of response to BCMA-directed therapies
Assess the clinical utility of MRD in prognosis and treatment of selected hematologic malignancies, including acute lymphoblastic leukemia, chronic lymphocytic leukemia, and multiple myeloma
Recurrent/Metastatic HNSCC: Harnessing Immunotherapy in Comprehensive Carei3 Health
i3 Health is pleased to make this slide deck from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck, presented by Glenn J. Hanna, MD, Director, Center for Cancer Therapeutic Innovation (Early Drug Development Program)
Medical Oncologist, Center for Head & Neck Oncology
Dana-Farber Cancer Institute, and Deborah Wong, MD, PhD, Associate Clinical Professor of Medicine, Division of Hematology-Oncology, UCLA Medical Center, was presented at a live educational event at the 2024 Multidisciplinary Head and Neck Cancers Symposium. It will provide expert perspectives on harnessing immunotherapy in recurrent/metastatic HNSCC to provide comprehensive care.
Slowing Progression of Chronic Kidney Disease Through Value-Based Carei3 Health
i3 Health is pleased to make this infographic from this activity available for use as a non-accredited self-study or teaching resource.
This two module CPE activity brings two leading pharmacists together to discuss the slowing progression of Chronic Kidney disease through value-based care.
In Module 1 of this activity, Jeff Sperry, PharmD, BCPS, Clinical Pharmacist at UCHealth Memorial Hospital, will explore risk factors contributing to CKD, efficacy and safety of novel therapies for slowing kidney function decline, and evidence-based strategies for management of CKD complications.
In Module 2 Justin J. Bioc, PharmD, BCPS, BCGP, RPh, Head of Clinical Pharmacy at Devoted Health, will explore the cost-effectiveness of novel therapies indicated to slow kidney function decline and strategies that maximize collaboration between payers and providers to optimize the care of patients with CKD.
Managing Immune-Related Adverse Events to Ensure Optimal Cancer Immunotherapy...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck, presented by Blanca Ledezma, MSN, NP, AOCNP® Nurse Practitioner
Hematology/Oncology
University of California, Los Angeles (UCLA) Health, will provide insight into the nurse’s view on managing immune-related adverse events to ensure optimal cancer immunotherapy outcomes.
Immune checkpoint inhibitors, which alter immune regulatory pathways and promote cell-mediated destruction of tumor cells, have revolutionized the treatment of cancer in recent years, with numerous therapeutic agents approved and several targets under investigation (Chennamadhavuni et al, 2022). However, up to 90% of patients receiving immune checkpoint inhibitors experience immune-related adverse events, which can affect a wide variety of organ systems and can occur at any time during treatment or even after treatment completion (NCCN, 2023). Immune-related adverse events are associated with significant morbidity as well as the risk of therapy discontinuation, which can have an unpredictable impact on patients’ disease course. Therefore, it is critical for nurses to understand the mechanism, identification, and timely management of immune-related adverse events (Shankar et al, 2022). In this activity presented by Blanca Ledezma, MSN, NP, AOCNP®, Nurse Practitioner at the University of California, Los Angeles (UCLA) Health, will provide insight into the nurse’s view on managing immune-related adverse events to ensure optimal cancer immunotherapy outcomes.
TARGET AUDIENCE
Oncology nurses, nurse practitioners, clinical nurse specialists, and other health care professionals involved in the management of patients with immune-related adverse events (IRAEs).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Discuss how the mechanisms of action of immunotherapies influence their safety profile
Identify risk factors predisposing patients to IRAEs
Distinguish IRAEs from chemotherapy- and targeted therapy-related adverse events
Coordinate with the interdisciplinary health care team to apply evidence-based guidelines and best practices in personalized nursing management plans for patients with IRAEs
Develop patient counseling strategies promoting awareness, self-monitoring, and escalated reporting of IRAEs
Putting the Freeze on Cold Agglutinin Diseasei3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by, Catherine M. Broome, MD, Associate Professor of Medicine at Georgetown University School of Medicine, will provide expert guidance on diagnostic features, current treatment standards, emerging therapies, and supportive care strategies for patients with cold agglutinin disease (CAD). Start the activity now!
STATEMENT OF NEED
Cold agglutinin disease (CAD) is a rare subtype of autoimmune hemolytic anemia (AIHA) in which antibodies cause hemolysis at cold temperatures, generally between 37º to 39º Fahrenheit. Approximately 1 in a million people are affected by CAD annually, with onset usually occurring between the ages of 40 and 80 years. Individuals commonly experience fatigue, dizziness, palpitations, and shortness of breath caused by the anemia; jaundice caused by degradation of hemoglobin into bilirubin; and sweating, coldness, or painful discoloration of their fingers, toes, ankles, and wrists triggered by exposure to cold (NORD, 2020). While progress has been made in recent years in understanding the pathogenesis of CAD, consensus recommendations based on randomized trials are needed for improving treatment outcomes and reducing symptom burden (Berentsen, 2021). In this Hematology/Oncology Fellows Lecture Series chaired by Catherine Broome, MD, Associate Professor of Medicine at Georgetown University School of Medicine, faculty will provide expert perspectives on optimizing the diagnosis, treatment, and supportive care of CAD.
TARGET AUDIENCE
Hematology fellows, attending faculty, and other health care professionals involved in the treatment of patients with cold agglutinin disease (CAD).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Evaluate the clinical and laboratory features of CAD that can inform timely and accurate diagnosis
Discuss the pathophysiology of CAD and the scientific rationale for targeting the classical complement pathway
Appraise the efficacy and safety of novel complement inhibitors for CAD as elucidated by recent studies
Assess strategies for managing anemia, cold-induced circulatory symptoms, and treatment-related adverse events to optimize the clinical outcomes of patients with CAD
Faculty
Catherine M. Broome, MD
Professor of Medicine
Georgetown University School of Medicine
Virtual Tumor Board: Multidisciplinary Management of Advanced Soft Tissue Sar...i3 Health
i3 Health is pleased to make the Clinical Decision Aid from this activity available for use as a non-accredited self-study or teaching resource.
Gain insights and perspectives from this multidisciplinary panel of experts as they discuss cases and explore strategies to optimize treatment outcomes for patients with advanced soft tissue sarcoma. This distinguished Virtual Tumor Board features Shreyaskumar R. Patel, MD, Medical Director of the Sarcoma Center at the University of Texas MD Anderson Cancer Center; Kathleen Polson, NP, Nurse Practitioner at Dana-Farber Cancer Institute; and Brian Rubin, MD, PhD, Professor of Pathology at Cleveland Clinic Cancer Center
STATEMENT OF NEED
Sarcomas, which represent 1% to 2% of adult cancers, are a rare, heterogeneous group of neoplasms originating in the connective tissue. Soft tissue sarcomas, which begin in the muscle, tendons, fat, lymph, blood vessels, and nerves, encompass more than 80 histological subtypes. Approximately 25% of patients develop metastatic disease after curative-intent surgery, and for these patients, treatment options are limited and prognosis is very poor. In recent decades, the identification of genetic alterations in soft tissue sarcoma has led to the rise of targeted therapy, significantly expanding the therapeutic landscape. Remaining up to date on pathological characteristics and emerging data on novel therapies is crucial (Riskjell et al, 2023; NCI, 2023). In this Virtual Tumor Board, Shreyaskumar R. Patel, MD, Medical Director of the Sarcoma Center at the University of Texas MD Anderson Cancer Center; Kathleen Polson, NP, Nurse Practitioner at Dana-Farber Cancer Institute; and Brian Rubin, MD, PhD, Professor of Pathology at Cleveland Clinic Cancer Center, will present cases and explore multidisciplinary strategies to optimize treatment outcomes for patients with advanced soft tissue sarcoma.
TARGET AUDIENCE
Medical/surgical/radiation oncologists, pathologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with soft tissue sarcoma.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Distinguish patient and tumor characteristics that can inform personalized therapeutic approaches in soft tissue sarcoma
Evaluate emerging data on novel therapies for soft tissue sarcoma
Appraise multidisciplinary strategies to optimize treatment outcomes of patients with advanced soft tissue sarcoma
FACULTY
Shreyaskumar R. Patel, MD
Robert R. Herring Distinguished Professor of Medicine
Center Medical Director, Sarcoma Center
The University of Texas
MD Anderson Cancer Center
Kathleen Polson, NP
Nurse Practitioner
Dana-Farber Cancer Institute
Brian Rubin, MD, PhD
Professor of Pathology
Chairman, Robert J. Tomsich Pathology and Laboratory Medicine Institute
Cleveland Clinic Cancer Center
Pathology and Oncology Expert Perspectives in the Management of Triple-Negati...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck, presented by Dr. Ira Bleiweiss, Chief of Breast Pathology at the University of Pennsylvania, and Dr. Sara Tolaney, Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, will feature expert pathology and oncology perspectives on the management of triple-negative breast cancer (TNBC), including case explorations and insights into frequently asked questions. Register today to hear these expert perspectives!
Statement of Need
Triple-negative breast cancer (TNBC) is an aggressive disease that accounts for approximately 10% to 15% of breast cancer diagnoses and is characterized by the absence of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2). TNBC is more common in Black women and in women under the age of 40 (ACS, 2023). Compared with other subtypes of invasive breast cancer, TNBC has high rates of metastasis and a poor prognosis. Due to the lack of hormone and receptor targets, therapeutic options are limited, and prognostication and treatment selection are complicated by the heterogeneity of the disease (Yang et al, 2022). In this live webinar, Dr. Sara Tolaney, Chief of the Division of Breast Oncology at Dana-Farber Cancer Institute, and Dr. Ira Bleiweiss, Chief of Breast Pathology at the Hospital of the University of Pennsylvania, will provide expert oncology and pathology perspectives on evidence-based strategies for diagnosis, treatment, and adverse event management for patients with TNBC.
TARGET AUDIENCE
Medical oncologists, surgical oncologists, radiation oncologists, pathologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with triple-negative breast cancer (TNBC).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Evaluate receptor and expression status for prognostication and treatment selection in TNBC
Differentiate the pathological characteristics of the various types of TNBC
Select optimal therapy for TNBC based on shared goals, biomarker testing, and clinical data on novel therapies
Discuss strategies for timely recognition and mitigation of adverse events associated with novel TNBC therapies
Current Standards and New Directions in the Treatment of Acquired Thrombotic ...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
Gain insight and expertise in this presentation on acquired thrombotic thrombocytopenic purpura. Spero Cataland, MD, Professor of Clinical Internal Medicine and Director of Benign Hematology at The Ohio State University, will provide guidance on current treatment standards and will discuss emerging therapies with the potential to improve patient outcomes in aTTP.
STATEMENT OF NEED
Acquired thrombotic thrombocytopenic purpura (aTTP) is a rare, life-threatening thrombotic microangiopathy with a rapid onset and progression and a mortality rate of 10% to 20% with prompt treatment. Onset of aTTP is characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, and a constellation of associated symptoms including hemorrhage, neurologic and renal manifestations, cardiac abnormalities, and mesenteric ischemia (Joly et al, 2017). Survivors of first aTTP events tend to have relapse events which need to be controlled. Rapid recognition and immediate appropriate treatment are critical for achieving optimized outcomes in aTTP. In this activity chaired by Spero Cataland, MD, Professor of Clinical Internal Medicine and Director of Benign Hematology at The Ohio State University, expert faculty will provide insightful guidance on current treatment standards and will discuss emerging therapies with the potential to improve patient outcomes in aTTP.
TARGET AUDIENCE
Hematology fellows, attending faculty, and other health care professionals involved in the treatment of patients with acquired thrombotic thrombocytopenic purpura (aTTP).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Evaluate the clinical and laboratory features of aTTP that can inform timely and accurate diagnosis
Discuss how ADAMTS13 activity can be used to guide the management of aTTP
Assess the mechanism of action, efficacy, and safety of novel anti-von Willebrand factor nanobodies in aTTP as elucidated by recent clinical trials
Evaluate novel treatment combinations and sequences with the potential to improve the outcomes of patients with aTTP
Expert Guidance on Current Standards and New Directions in Newly Diagnosed Mu...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
Presented by leading expert Urvi Shah, MD, Assistant Attending in the Myeloma Service at Memorial Sloan Kettering Cancer Center, this slide deck will explore guidance on current standards and new directions in newly diagnosed multiple myeloma.
STATEMENT OF NEED
An estimated 35,730 new cases of multiple myeloma are diagnosed in the United States annually, and 12,590 people die of the disease (Siegel et al, 2023). Characterized by clonal proliferation of malignant plasma cells in the bone marrow, multiple myeloma is associated with anemia, renal insufficiency, bone destruction, and hypercalcemia, all of which significantly impact patients’ quality of life. The development of novel therapies and combinations in recent years, including anti-CD38 antibodies, has provided numerous therapeutic options for newly diagnosed multiple myeloma. However, the optimal selection of induction therapy and subsequent treatment sequencing for individual patients remains a challenge. Additionally, factors including age, frailty, comorbidities, transplant eligibility, treatment-related toxicities, and supportive care needs complicate treatment decisions (Costello et al, 2022). This hematology/oncology fellows lecture series will explore expert guidance on current standards and new directions in newly diagnosed multiple myeloma.
TARGET AUDIENCE
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with multiple myeloma.
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Assess guideline-recommended treatment combination and sequencing strategies in NDMM
Evaluate the role of minimal residual disease (MRD) assessment in NDMM treatment
Review the mechanism of action, efficacy, and safety of anti-CD38 monoclonal antibodies in the treatment of NDMM
Discuss strategies to monitor and manage treatment-related toxicities and optimize survivorship care
Hitting the Target in HER2-Positive Metastatic Colorectal Canceri3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck will share the latest data and strategies for hitting the target in HER2-positive metastatic colorectal cancer. Dr. Christopher Lieu, Associate Professor at the University of Colorado Cancer Center, explores actionable targets to inform personalized care plans, guideline-recommended combination and sequencing strategies, adverse event monitoring and management, and more.
STATEMENT OF NEED
An estimated 153,020 new cases of colorectal cancer (CRC) are diagnosed annually, and 52,550 people die of the disease (Siegel et al, 2023). Approximately 22% of patients present with metastatic disease, which is associated with a dismal 5-year survival rate of 15% (SEER, 2022). Targeting biomarkers is a key strategy for expanding therapeutic options and improving outcomes in metastatic CRC. Human epidermal growth factor receptor 2 (HER2) amplification status and treatments targeting HER2 are some of the most recent additions to the arsenal of targeted therapy for this disease. This activity chaired by Christopher Lieu, MD, Associate Director of Clinical Research at the University of Colorado Cancer Center, will provide expert perspectives and practical guidance on treating HER2-positive metastatic CRC.
TARGET AUDIENCE
Oncologists, gastroenterologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with colorectal cancer (CRC).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Distinguish actionable targets that can inform personalized care plans in metastatic CRC
Evaluate practice guidelines on treatment combinations and sequences for patients with metastatic CRC
Appraise emerging efficacy and safety data on novel targeted therapies for patients with HER2-positive metastatic CRC
Assess strategies for optimizing the safety and tolerability of novel targeted therapies for HER2-positive metastatic CRC
Leveraging BCMA-Directed Therapies for Improved Patient Outcomes in Relapsed/...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Rahul Banerjee, Assistant Professor at the University of Washington and Fred Hutchinson Cancer Center, will provide a case-based discussion on leveraging BCMA-directed antibody-drug conjugates, CAR T-cell therapies, and bispecific T-cell engagers to improve outcomes for patients with multiple myeloma in need of additional treatment options.
STATEMENT OF NEED
Multiple myeloma is a disease that remains incurable for most patients, many of whom become refractory to the majority of available treatments (Kumar et al, 2022). It is estimated that 35,730 new cases of multiple myeloma are diagnosed in the United States annually, and 12,590 people die of the disease (Siegel et al, 2023). Agents targeting B-cell maturation antigen (BCMA), including antibody-drug conjugates (ADCs), chimeric antigen receptor (CAR) T-cell therapies, and bispecific T-cell engagers, represent a promising therapy class for patients in need of additional treatment options, including those with higher genetic risk and heterogeneity (Kumar et al, 2022). This activity led by Rahul Banerjee, MD, FACP, Assistant Professor in the Division of Medical Oncology at the University of Washington and Fred Hutchinson Cancer Center, will provide strategies for leveraging BCMA-directed therapies for improved patient outcomes in relapsed/refractory multiple myeloma.
TARGET AUDIENCE
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with multiple myeloma (MM).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to:
Evaluate the mechanisms of action, efficacy, and safety of BCMA-directed therapies in relapsed/refractory MM
Assess guideline-recommended combination and sequential treatment strategies for relapsed/refractory MM
Identify risk factors for the development of treatment-specific adverse events with different classes of BCMA-directed therapies
Describe mechanisms of drug resistance/loss of response to BCMA-directed therapies
Examine the roles of gene expression profiling, soluble BCMA, and measurable residual disease (MRD) in clinical practice.
Optimizing Therapeutic Strategies in Castration-Resistant Prostate Canceri3 Health
This activity will discuss emerging efficacy and safety data on novel therapies for nmCRPC and mCRPC, strategies to manage adverse events, and the role of imaging studies and PSA testing in evaluating treatment response.
Optimizing Treatment Sequencing for Patients With Relapsed/ Refractory Multi...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Shaji Kumar, MD, Professor of Hematological Malignancies
Mayo Clinic Cancer Center, offers expert insight on the assessment of MM, emerging and current therapies, cutting edge approaches to personalized treatments plans, and much more.
Tailoring Therapy for Follicular Lymphoma Based on the Latest Evidencei3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This live or zoom broadcasted hematology/oncology fellowship program will bring an expert faculty member to your institution to discuss the latest developments and expert perspectives in the treatment of follicular lymphoma.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Challenges and Opportunities in Metastatic Gastric Cancer
1. www.i3Health.com
Clinical Tools and Resources
for Self-Study and Patient Education
Gastric Cancer
Reference Guide
The clinical tools and resources contained herein are provided as educational adjuncts to the
CME/CE-approved online activity Challenges and Opportunities in Metastatic Gastric Cancer. To
access the activity and earn CME/CE credit, visit:
www.i3Health.com/gastric-cancer
Contents
I. TNM Staging of Gastric Tumors.........................................................................................................2
II. General Staging of Gastric Cancer....................................................................................................3
III. Gastric Cancer: General Treatment..................................................................................................5
IV. Gastric Cancer: Components of Treatment .....................................................................................6
V. Systemic Therapy for Gastric Cancer: Adverse Events .....................................................................7
VI. Gastrectomy: Patient Guidelines for Adverse Events ....................................................................10
VII. Post-Gastrectomy Eating Guidelines ............................................................................................12
2. 089GC Reference Guide | Page 2 of 12
www.i3Health.com
I. TNM STAGING OF GASTRIC TUMORS
TNM Clinical Classifications
Tumor
TX Primary tumor cannot be evaluated
T0 There is no evidence of primary tumor in the stomach
Tis
Carcinoma in situ. Cancer is found only in cells on the epithelium (the surface of the inner lining of the
stomach) and has not spread to any other layers of the stomach
T1
Tumor has grown into lamina propria, muscularis mucosae, or submucosa (inner layers of the wall of the
stomach)
T1a Tumor has grown into the lamina propria or muscularis mucosae
T1b Tumor has grown into the submucosa
T2 Tumor has grown into the muscularis propria (muscle layer of the stomach)
T3
Tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach,
but it has not grown into the peritoneal lining (the lining of the abdomen) or into the serosa
T4
Tumor has grown through all of the layers of the muscle into the connective tissue outside the stomach
and into the peritoneal lining, serosa, or organs surrounding the stomach
T4a Tumor has grown into the serosa
T4b Tumor has grown into organs surrounding the stomach
Node
NX Regional lymph nodes cannot be evaluated
N0 Cancer has not spread to the regional lymph nodes
N1 Cancer has spread to 1-2 regional lymph nodes
N2 Cancer has spread to 3-6 regional lymph nodes
N3 Cancer has spread to ≥7 regional lymph nodes
N3a Cancer has spread to 7-15 regional lymph nodes
N3b Cancer has spread to ≥16 regional lymph nodes
Metastasis
MX Distant metastasis (spread to other sites in the body) cannot be evaluated
M0 No metastasis
M1 Metastasis
American Society of Clinical Oncology (2019). Stomach cancer: stages. Available at: https://www.cancer.net/cancer-types/stomach-
cancer/stages
3. 089GC Reference Guide | Page 3 of 12
www.i3Health.com
II. GENERAL STAGING OF GASTRIC CANCER
Cancer Stage Grouping
Stage Description
0 Carcinoma in situ (Tis, N0, M0)
IA
The cancer has grown into the inner layer of the stomach wall with no spread to lymph nodes or other organs
(T1, N0, M0)
IB
The cancer satisfies either of the following criteria:
• Growth into the inner layers of the stomach wall with spread to 1-2 lymph nodes but not elsewhere (T1,
N1, M0)
• Growth into the outer muscular layers of the stomach wall without spread to lymph nodes or other organs
(T2, N0, M0)
IIA
The cancer satisfies any of the following criteria:
• Growth into the inner layer of the stomach wall with spread to 3-6 lymph nodes but not elsewhere (T1, N2,
M0)
• Growth into the outer muscular layers of the stomach wall with spread to 1-2 lymph nodes but not
elsewhere (T2, N1, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach without
growth into the peritoneal lining or serosa or spread to lymph nodes or surrounding organs (T3, N0, M0)
IIB
The cancer satisfies any of the following criteria:
• Growth into the inner layers of the stomach wall with spread to 7-15 lymph nodes but not elsewhere (T1,
N3a, M0)
• Invasion of the outer muscular layers of the stomach wall and spread to 3-6 lymph nodes but not
elsewhere (T2, N2, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach but not into
the peritoneal lining or serosa; spread to 1-2 lymph nodes but not elsewhere (T3, N1, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach and into the
peritoneal lining or serosa without spread to lymph nodes or surrounding organs (T4a, N0, M0)
IIIA
The cancer satisfies any of the following criteria:
• Growth into the outer muscular layers of the stomach wall with spread to 7-15 lymph nodes but not to
other organs (T2, N3a, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach but not into
the peritoneal lining or serosa; spread to 3-6 lymph nodes but not to other organs (T3, N2, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach and into the
peritoneal lining or serosa; spread to 1-2 lymph nodes but not to other organs (T4a, N1, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach and into
nearby organs or structures without spread to lymph nodes or distant sites (T4b, N0, M0)
4. 089GC Reference Guide | Page 4 of 12
www.i3Health.com
Cancer Stage Grouping (cont.)
Stage Description
IIIB
The cancer satisfies any of the following criteria:
• Growth into the inner layer of the stomach wall or the outer muscular layers of the stomach wall with
spread to ≥16 lymph nodes but not to distant sites (T1 or T2, N3b, M0)
• Growth through all layers of the muscle into the connective tissue outside the stomach but not into the
peritoneal lining or serosa; spread to 7-15 lymph nodes but no invasion of surrounding organs (T3, N3a,
M0)
• Growth through all layers of the muscle into connective tissue outside the stomach and into the peritoneal
lining or serosa; spread to 7-15 lymph nodes but not elsewhere (T4a, N3a, M0)
• Growth through all of the layers of the muscle into the connective tissue outside the stomach and into
nearby organs or structures, with or without spread to 1-6 lymph nodes; no spread to distant sites (T4b,
N1 or N2, M0)
IIIC
The cancer satisfies either of the following criteria:
• Growth through all layers of the muscle into the connective tissue outside the stomach and possibly into
the peritoneal lining or serosa; spread to ≥16 lymph nodes but not to distant sites (T3 or T4a, N3b, M0)
• Growth through all of the layers of the muscle into the connective tissue outside of the stomach and into
nearby organs or structures; spread to ≥7 lymph nodes but not to distant sites (T4b, N3a or N3b, M0)
IV A cancer of any size that has spread to distant sites in addition to the area surrounding the stomach
American Society of Clinical Oncology (2019). Stomach cancer: stages. Available at: https://www.cancer.net/cancer-types/stomach-
cancer/stages
5. 089GC Reference Guide | Page 5 of 12
www.i3Health.com
III. GASTRIC CANCER: GENERAL TREATMENT
Treatment by Stage
Stage 0 Endoscopic resection
Stage IA Cancer removal by total or subtotal gastrectomy
Stage IB Cancer removal by total or subtotal gastrectomy
Stage II-III
• Surgery to remove all or part of the stomach, omentum, and nearby lymph nodes
• Chemotherapy or chemoradiation may be given before, after, or both before and after
surgery
Stage IV
• Surgery such as a gastric bypass or subtotal gastrectomy, chemotherapy, or radiotherapy
can be used to try to keep the cancer under control and help relieve symptoms
• Targeted therapy
American Cancer Society (2019). Treatment choices by type and stage of stomach cancer. Available at:
https://www.cancer.org/cancer/stomach-cancer/treating/by-stage.html
6. 089GC Reference Guide | Page 6 of 12
www.i3Health.com
IV. GASTRIC CANCER: COMPONENTS OF TREATMENT
Gastric Cancer Treatment
Treatment Description
Surgery
• Partial or total gastrectomy
o Can be used in conjunction with chemotherapy or radiotherapy
Radiotherapy • Can be used in conjunction with surgery and/or chemotherapy
Chemotherapy
• Can be used in conjunction with surgery and/or radiotherapy
• Chemotherapy drugs used for gastric cancer:
o Cisplatin (Platinol®
)
o Fluorouracil (Adrucil®
)
o Capecitabine (Xeloda®
)
o Docetaxel (Docefrez®, Taxotere®
)
o Epirubicin (Ellence®
)
o Irinotecan (Camptosar®
, Onivyde®
)
o Oxaliplatin (Eloxatin®)
o Paclitaxel (Taxol®
, Onxal®
)
Targeted
Therapy
• Treatment that targets specific genes, proteins, or the tissue environment that
contributes to cancer growth and survival
• Human epidermal growth factor receptor 2 (HER2)-targeted therapy for HER2-
positive (HER2+) cancer
o Treated with trastuzumab (Herceptin®
) plus chemotherapy in later-stage cancer
• Antiangiogenesis therapy focuses on stopping the process of making new blood
vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and
spread, the goal of antiangiogenesis therapies is to “starve” the tumor
o For patients whose tumors has grown while receiving initial chemotherapy,
ramucirumab (Cyramza®
) could be an option
Immunotherapy
• Designed to boost the body’s natural defenses to fight the cancer
o Pembrolizumab (Keytruda®
), an anti-PD-1 checkpoint immunotherapy approved
for patients with advanced, relapsed stomach cancer that expresses
programmed death ligand 1 (PD-L1)
Palliative Care • Lengthens life and relieves symptoms for those with metastatic gastric cancer
American Society of Clinical Oncology (2019). Stomach cancer: treatment options. Available at: https://www.cancer.net/cancer-
types/stomach-cancer/treatment-options
Cancer Research Institute (2019). How is immunotherapy changing the outlook for patients with stomach cancer? Available at:
https://www.cancerresearch.org/immunotherapy/cancer-types/stomach-cancer
7. 089GC Reference Guide | Page 7 of 12
www.i3Health.com
V. SYSTEMIC THERAPY FOR GASTRIC CANCER: ADVERSE EVENTS
Potential Adverse Events
5-Fluorouracil
and
Capecitabine
• Palmar-plantar syndrome:
o Soreness of the palms of the hands and soles of the feet
o Tingling, numbness, pain, and dryness
o Rarely, palmar-plantar syndrome can cause a spasm in the arteries that supply the heart
with blood, causing chest pain similar to that of angina
Cisplatin
• Hearing loss
• Kidney damage
o To avoid this, drink plenty of water during treatment
Epirubicin
• Red or pink urine for a few days after treatment
• Skin that is more sensitive to sunlight; reddening in areas where the patient has had
radiotherapy in the past
• Damage to the heart muscle (rare)
Oxaliplatin
• Neuropathy (temporary or permanent damage to the nerves that affect the fingers and toes,
causing numbness or pins and needles)
Irinotecan
• Increased sweating and salivary production
• Watery eyes
• Abdominal cramps and sometimes severe diarrhea
Docetaxel
• Fluid retention
• Temporary nail discoloration
• Itchy skin rash
• Palmar-plantar syndrome (see description under “5-Fluorouracil and Capecitabine” above)
• Simple numbness or tingling in the hands and feet
• About 1 in 4 patients suffer from an allergic reaction during the first or second infusion
Trastuzumab
• Common: allergic reactions that can involve chills, fever, itchy rash, feeling of sickness,
breathlessness, wheezing, headaches, flushes, and/or faintness
• Heart problems that usually resolve once treatment is discontinued
Trifluridine/
Tipiracil
• Myelosuppression:
o Anemia
o Neutropenia
o Thrombocytopenia
o Febrile neutropenia
European Society for Medical Oncology (2012). Stomach cancer: a guide for patients. Available at:
https://www.esmo.org/content/download/6635/115239/file/EN-Stomach-Cancer-Guide-for-Patients.pdf
Lonsurf®
(trifluridine/tipiracil) prescribing information (2019). Taiho Oncology. Available at:
https://www.taihooncology.com/us/prescribing-information.pdf
8. 089GC Reference Guide | Page 8 of 12
www.i3Health.com
Potential Adverse Events (cont.)
Pembrolizumab
• Pneumonitis (a lung condition): shortness of breath, chest pain, or new/worse cough
• Colitis (intestinal problems that can lead to intestinal tears or perforations). Signs/symptoms:
o Diarrhea or more bowel movements than usual
o Stools that are black, tarry, sticky, or have blood or mucus
o Severe abdomen pain/tenderness
• Hepatitis (inflammation of the liver). Signs/symptoms:
o Yellowing of the skin or the whites of the eyes
o Nausea or vomiting
o Pain on the right side of the abdomen
o Dark urine
o Loss of appetite
o Easy bleeding or bruising
• Hormone gland problems, especially the thyroid, pituitary, adrenal glands, and pancreas.
Signs/symptoms:
o Rapid heartbeat
o Weight loss or gain
o Increased sweating
o Increased hunger or thirst
o Increased frequency of urination
o Hair loss
o Chills
o Constipation
o Deepening of the voice
o Muscle aches
o Dizziness or fainting
o Unusual headaches or headaches that will not go away
• May cause nephritis and kidney failure. Signs include change in the amount or color of urine
• Skin problems
o Rash, itching, blisters, peeling
o Skin sores
o Painful sores or ulcers in the mouth, nose, throat, or genital area
• Problems in other organs:
o Vision changes
o Severe or persistent muscle or joint pains; severe muscle weakness
o Anemia (low red blood cell count)
o Sarcoidosis
§ Swollen lymph nodes, rash or tender lumps on skin, cough, shortness of breath, vision
changes, and/or eye pain
o Encephalitis
§ Confusion, fever, muscle weakness, balance problems, nausea or vomiting, stiff neck,
memory problems, and/or seizures
o Myocarditis
§ Shortness of breath, irregular heartbeat, feeling tired, and/or chest pain
Keytruda® (pembrolizumab) prescribing information (2018). Available at: http://keytruda.com
9. 089GC Reference Guide | Page 9 of 12
www.i3Health.com
Potential Adverse Events (cont.)
Ramucirumab
• Hemorrhage and gastrointestinal hemorrhage, including severe and sometimes fatal
hemorrhagic events
• Arterial thromboembolic events, including myocardial infarction, cardiac arrest,
cerebrovascular accident, and cerebral ischemia
• Hypertension
o Important to control blood pressure before treatment and monitor throughout treatment
• Infusion-related reactions. Signs/symptoms:
o Rigors/tremors, back pain/spasms, chest pain and/or tightness, chills, flushing, dyspnea,
wheezing, hypoxia, and paresthesia
o In severe cases: bronchospasm, supraventricular tachycardia, and hypotension
• Gastrointestinal perforations
• Impaired wound healing
o Withhold treatment prior to surgery
• Proteinuria, including nephrotic syndrome
o Important to monitor proteinuria by urine dipstick and/or urinary protein creatinine ratio
o Withhold ramucirumab for urine protein levels ³2 g over 24 hours
o Reinitiate ramucirumab at a reduced dose once urine protein level returns to <2 g over
24 hours
o Permanently discontinue ramucirumab for urine protein levels >3 g over 24 hours or in
the setting of nephrotic syndrome
• Thyroid dysfunction
• Embryofetal toxicity
• In patients with Child-Pugh B or C cirrhosis, may cause clinical deterioration manifested by
new-onset or worsening encephalopathy, ascites, or hepatorenal syndrome
Cyramza®
(ramucirumab) prescribing information (2018). Available at: http://cyramza.com
10. 089GC Reference Guide | Page 10 of 12
www.i3Health.com
VI. GASTRECTOMY: PATIENT GUIDELINES FOR ADVERSE EVENTS
Gastrectomy: Adverse Events
Surgical
Complications
• Wound infection
• Leaking from a join made during surgery
• Stricture (stomach acid leaks into the esophagus and causes scarring, leading to the esophagus
becoming narrow and constricted)
• Chest infection
• Internal bleeding
• Blockage of the small intestine
Vitamin
Deficiency
• One of the stomach’s functions is to absorb vitamins, particularly B12, C, and D, from food. If the
stomach is removed, the patient may not get these vitamins
• Lack of these vitamins causes
o Anemia
o Increased vulnerability to infection
o Osteoporosis and weakened muscles
• Patient may need to make dietary changes or take vitamin supplements
Weight Loss
• Patient may feel full quickly and eat less
• Important to consult a dietician
Dumping
Syndrome
• Food moves too fast into the small intestine, particularly sugary and starchy food
o Before the gastrectomy, the stomach digested most of the sugar and starch. Now, the small
intestine has to draw in water to digest sugar and starch
• 1.5 liters of water can enter the small intestine, much of it taken from blood. This can cause a
sudden fall in blood pressure, resulting in the following symptoms:
o Faintness
o Sweating
o Palpitations
o A need to lie down
• Extra water in the small intestine can cause the following symptoms:
o Bloating
o Rumbling noises
o Nausea
o Indigestion
o Diarrhea
• To ease the symptoms of dumping syndrome:
o Rest for 20-45 minutes after each meal
o Eat slowly
o Avoid sugary foods
o Slowly increase dietary fiber intake
o Avoid soup and other liquids
o Eat smaller, more frequent meals
11. 089GC Reference Guide | Page 11 of 12
www.i3Health.com
Gastrectomy: Adverse Events (cont.)
Morning
Vomiting
• Bile (fluid used by the digestive system to break down fats) and digestive juices build up in the
duodenum (the first part of the small intestine) overnight
• Because the stomach is smaller, an uncomfortable feeling of fullness may occur, triggering the
vomit reflex
• Indigestion medication may help to reduce these symptoms
• Consult with a general practitioner
Diarrhea
• The vagus nerve, which helps to control the movement of food through the digestive system, is
sometimes cut during a gastrectomy. This causes diarrhea
Heartburn
(Acid Reflux)
• To relieve heartburn, sit in an upright position for at least one hour after eating
• Medications can also provide symptom relief
National Health Service (2018). Gastrectomy complications. Available at: https://www.nhs.uk/conditions/gastrectomy/risks/
12. 089GC Reference Guide | Page 12 of 12
www.i3Health.com
VII. POST-GASTRECTOMY EATING GUIDELINES
Patient Instructions on Post-Gastrectomy Eating
• Eat 6 or more small meals a day instead of 3 main meals
o This will help you to eat the right amount of food, even though your stomach is smaller or gone
• Eat slowly and chew your food well to help with digestion
o This will enable you to stop eating before you get too full and feel uncomfortable
• Do not drink more than 4 ounces (1/2 cup) of liquid during meals
o This will allow you to eat enough solid food without getting too full and will slow down digestion of your food
• Drink most of your liquids at least 1 hour before or 1 hour after meals to prevent dehydration
• Drink about 8-10 glasses of liquid per day (a glass is considered 8 ounces)
o Avoid carbonated beverages if they make you feel full
• Test your tolerance to sweets
o Sugar in foods and liquids may cause water to be drawn into your stomach or small intestine. Your food will
then move too quickly through your small intestine. This is called dumping syndrome. It may cause cramping,
stomach pain, or diarrhea. These symptoms start within about 20 minutes of eating
o Low blood sugar can happen to 1-2 hours after a sugary meal. Symptoms include feeling weak, hungry,
nauseous, anxious, shaky, and sweaty. The symptoms can be controlled by changing your diet and watching
what you eat. Ask a dietitian for more information
• Test your tolerance to fats
o You may have trouble digesting large amount of fat. Try a small amount first and then increase it slowly
o Foods high in fat:
§ Butter, margarine, and oils
§ Mayonnaise and gravies
§ Creamy salad dressings and cream cheese
§ Potato and corn chips
§ Rich desserts and fried foods
• Slowly bring dairy products back into your diet
o Some people may become lactose intolerant after having a gastrectomy. This means that they have trouble
digesting lactose, a type of alcohol sugar found in dairy products
o Sometimes, lactose intolerance that develops after surgery will go away with time
o Symptoms of lactose intolerance (gas, bloating, and diarrhea) usually start soon after eating dairy products
o To test your tolerance to dairy foods, start by drinking a 4-ounce (1/2 cup) serving of milk. If you do not have
any symptoms of lactose intolerance, you can start eating more dairy foods
o Examples of foods with large amounts of lactose are milk, ice cream, and soft cheeses
o If you become lactose intolerant, you may still be able to eat hard cheeses, yogurt, and butter. These foods
have smaller amounts of lactose than other dairy products
o If you think you may be lactose intolerant, consult your dietitian
o Products such as lactose-free milk, tablets, or drops can help you to digest dairy products
o You may want to try dairy products again in a couple of months to see if you can tolerate them
• You may need a monthly shot of vitamin B12 and vitamin and mineral supplements
• Tell your doctor if you are losing weight
Memorial Sloan Kettering Cancer Center (2014). Eating after your gastrectomy or esophagogastrectomy. Available at:
https://www.mskcc.org/cancer-care/patient-education/eating-after-your-gastrectomy-esophagogastrectomy