In today's episode, we welcome Dr. Sandip Patel, who is a Professor of Medical Oncology at the University of California, San Diego, to discuss the evolution of molecular profiling technology, focusing on how next-generation sequencing can help support patients with advanced thyroid cancer, but also how to integrate molecular profiling into clinical practice.

Learning Objective(s):

After completing this educational activity, learners will be able to discuss precision medicine and new technologies, including liquid biopsy

Funding Information:

This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in collaboration with an independent steering committee; Eli Lilly had no influence on the content of this educational activity.

Accreditation:

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the ACHL and Liberum IME. ACHL is accredited by the ACCME to provide continuing medical education for physicians.

The Academy for Continued Healthcare Learning (ACHL) designates this enduring material for up to 0.25 AMA PRA Category 1 Credits™. Physicians should claim credit commensurate with the extent of their participation in the activity.

The American Medical Association (AMA) has an agreement of mutual recognition of Continuing Medical Education (CME) credits with the European Union of Medical Specialists (UEMS), the accreditation body for European countries. Physicians interested in converting AMA PRA Category 1 Credit™ to UEMS-European Accreditation Council for Continuing Medical Education CME credits (ECMEC®s) should contact the UEMS at [email protected]

The content for this activity was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

Faculty disclosures

Dr. Sandip Patel:

Scientific advising (Ongoing): Amgen, AstraZeneca, BeiGene, Bristol-Myers Squibb, Certis, Eli Lilly, Jazz, Genentech, Illumina, Merck, Pfizer, Rakuten, and Tempus

Institutional research funding (Ongoing): Amgen, AstraZeneca/MedImmune, Bristol-Myers Squibb, Eli Lilly, Fate Therapeutics, Gilead, Iovance, Merck, Pfizer, Roche/Genentech, SQZ Biotechnologies"

Other disclosures

Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

In today's episode, we welcome Dr. Conor Steuer, which is Associate Professor at the Department of Hematology and Medical Oncology at Emory University School of Medicine in Atlanta, USA, to discuss adaptation of thyroid cancer guidelines to local care settings. We touch on strategies for guideline implementation and how to overcome potential barriers.

Target Audience:

Oncologists, pathologists and other HCPs involved in the diagnosis of RET and TRK cancers, with a focus on community practitioners.

Learning Objective(s):

After completing this educational activity, learners will be able to:

• Recall thyroid RET and TRK fusion-positive cancer diagnosis and relevant genomic testing guidelines, and identify ways to adapt the guidelines to local settings

• Review the organization of care and strategies for more efficient care delivery

Funding Information:

This independent educational activity is supported by an educational grant from Eli Lilly. The educational content has been developed by Liberum IME in collaboration with an independent steering committee; Eli Lilly had no influence on the content of this educational activity.

Accreditation:

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the ACHL and Liberum IME. ACHL is accredited by the ACCME to provide continuing medical education for physicians.

The Academy for Continued Healthcare Learning (ACHL) designates this enduring material for up to 0.25 AMA PRA Category 1 Credits™. Physicians should claim credit commensurate with the extent of their participation in the activity.

The American Medical Association (AMA) has an agreement of mutual recognition of Continuing Medical Education (CME) credits with the European Union of Medical Specialists (UEMS), the accreditation body for European countries. Physicians interested in converting AMA PRA Category 1 Credit™ to UEMS-European Accreditation Council for Continuing Medical Education CME credits (ECMEC®s) should contact the UEMS at [email protected]

The content for this activity was developed independently of the ineligible companies. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantors.

This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.

Faculty disclosures:

Conor Steuer

Advisory Board/Steering Committee (Ongoing): Daiichi

Advisory Board (Former): Caris, Merck, Mirati, Novocure, Sanofi/Regeneron

Other disclosures

Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

Developments in precision medicine have led to a paradigm shift in the management of advanced thyroid cancer. The ESMO Guidelines Committee recently developed a new clinical practice guideline on the use of systemic therapy in this setting.

This episode offers guideline insights into the applications recently approved therapies that have been approved by the FDA and/or the EMA, including cabozantinib, selpercatinib, pralsetinib, and entrectinib. It also provides data updates of previously approved therapies and how guidelines have been adapted accordingly. To answer questions on the 2022 ESMO Clinical Practice Guideline update, we have invited Dr. Ahmad Awada to join us. He is Head of the Oncology Medicine Department at Jules Bordet Cancer Institute Brussels, Belgium.

Target Audience:

Funding information:

Disclosures

In today’s episode, we welcome expert Oncologist Dr. Claire Arthur and expert Endocrinologist Dr. Sarimar Agosto Salgado to discuss the challenges they have encountered and strategies that they have implemented to improve multidisciplinary collaboration in the management of patients with thyroid cancer and continued integration of precision medicine approaches.

References

1. Fenton ME et al. Variability in thyroid cancer multidisciplinary team meeting recommendations is not explained by standard variables: Outcomes of a single centre review. J Clin Med 2021;10:4150

2. Horgan D et al. Tackling thyroid cancer in Europe—The challenges and opportunities. Healthcare 2022;10:1621

3. Mehra S et al. Improving the quality of thyroid cancer care: How does the Thyroid Cancer Care Collaborative cross the Institute of Medicine’s Quality Chasm? Thyroid 2014;24:615–624

Target Audience:

Oncologists, pathologists and other HCPs involved in the diagnosis of RET and TRK cancers, with a focus on community practitioners.

Learning Objective:

1. Recall thyroid RET andTRK fusion-positive cancer diagnosis and relevant genomic testing guidelines and identify ways to adapt the guidelines to local settings

2. Discuss “precision medicine” and new technologies, including “liquid biopsy”

3. Review the organisation of care and strategies for more efficient care delivery

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

Disclosures:

Dr Sarimar Agosto Salgado: 

- Speaker: Lilly

- Advisor: Exelisis, Lilly, Blueprint medicines, Eisai

Dr Claire Arthur

Dr Claire Arthur has no relevant disclosures against this module

Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.

In today’s episode, we welcome Dr. Antonio Matrone, an endocrinologist at the University of Pisa, to discuss the many factors involved in treatment decision-making and strategies for the management of patients with advanced thyroid cancer where an oncogenic driver has been identified.

References

Target Audience:

Oncologists, pathologists and other HCPs involved in the diagnosis of RET and TRK cancers, with a focus on community practitioners.

Learning Objective:

These learning objectives are for the podcast series. This episode focuses on the first and third objective.

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

Staff Disclosure:

Dr. Matrone declares the following:

Consultant - Eli Lilly

In today’s episode, we welcome Principal Researcher Dr. David Tamborero who was integral to the development of the Molecular Tumor Board Portal to discuss the benefits associated with molecular tumor boards and the way in which the portal can support the discussions that take place at tumor board meetings, as well as how these initiatives can support the management of patients with thyroid cancer.

References

Target Audience:

Oncologists, pathologists and other HCPs involved in the diagnosis of RET and TRK cancers, with a focus on community practitioners.

Learning Objective:

These learning objectives are for the podcast series. This episode focuses on the second and third objective.

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

Staff Disclosure:

Dr. David Tamborero has no relevant disclosures to announce

In today’s episode, we welcome expert Oncologist Dr. Lori Wirth and expert Pathologist Dr. Thomas Giordano to discuss the challenges they have encountered and strategies that they have implemented to improve multidisciplinary collaboration in the management of patients with thyroid cancer and continued integration of precision medicine approaches.

References

Target Audience:

Oncologists, pathologists and other HCPs involved in the diagnosis of RET and TRK cancers, with a focus on community practitioners.

Learning Objective:

These learning objectives are for the podcast series. This episode focuses on the third objective.

By completing this module you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment.

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

Staff Disclosures:

Dr Lori Wirth

Advisory Board - Bayer Healthcare, Coherus, Eli Lilly, Eisai, Exelixis, PDS Biotechnology Corp

Consultant - Curie Therapeutics, Morphic Therapeutics

Dr. Thomas Giordano

No relevant disclosures to declare

Liquid biopsy has emerged as a novel diagnostic tool, enabling rapid, non-invasive molecular testing of thyroid cancers. This episode offers insight into some of the opportunities and challenges that are presented by liquid biopsy in this field. To answer questions on this topic, we have invited Professor Frederique Penault-Llorca to join us. She is Professor of Pathology at the University of Clermont-Ferrand and CEO of the Comprehensive Regional Cancer Institute Centre Jean Perrin in Clermont-Ferrand, France.

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

Faculty Disclosures:

Professor Frederique Penault-Llorca has disclosures are as follows:

Advisory board: Roche, EliLilly, Illumina,

Speaker: Roche, EliLilly, Illumina,

References

1. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–1214

2. Albarel F, Conte-Devolx B, Oliver C. From nodule to differentiated thyroid carcinoma: Contributions of molecular analysis in 2012. Ann Endocrinol (Paris). 2012;73:155–164

3. Nylen C, Mechera R, Marechal-Ross I, et al. Molecular markers guiding thyroid cancer management. Cancers (Basel). 2020;12:2164

4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. Version 2.2022. May 5, 2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf (accessed June 2022)

5. Pinchot SN, Al-Wagih H, Schaefer S, et al. Accuracy of fine-needle aspiration biopsy for predicting neoplasm or carcinoma in thyroid nodules 4 cm or larger. Arch Surg. 2009;144:649–655

6. Bellevicine C, Sgariglia R, Nacchio M, et al. Molecular testing of thyroid fine-needle aspiration: local issues and solutions. An interventional cytopathologist perspective. J Mol Pathol. 2021;2:233–240

7. Kasraeian S, Allison DC, Ahlmann ER, et al. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res. 2010;468:2992–3002

8. Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: Guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med. 2018;142:321–346

9. Pennell NA, Arcila ME, Gandara DR, et al. Biomarker testing for patients with advanced non-small cell lung cancer: Real-world issues and tough choices. Am Soc Clin Oncol Educ Book. 2019;39:531–542

10. Belli C, Penault-Llorca F, Ladanyi M, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021;32:337–350

11. Li MM, Datto M, Duncavage EJ, et al. Standards and guidelines for the interpretation and reporting of sequence variants in cancer: A joint consensus recommendation of the Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists. J Mol Diagn. 2017;19:4–23

Developments in RET-targeted therapies have led to a paradigm shift in the management of advanced thyroid cancer. However, resistance to these drugs has been observed to develop through a variety of mechanisms, so precise monitoring is required to detect and react to disease development.

This episode offers insight into relevant mechanisms of resistance to RET inhibitors in thyroid cancer. It also considers how strategies such as combinations of targeted therapies and liquid biopsy could potentially help tackle the development of resistance. To answer questions on this topic, we have invited Professor Bruce Robinson to join us. He is a Professor of Medicine and Endocrinologist at the University of Sydney, Australia.

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

References

Rearranged during transfection (RET) and tropomyosin receptor kinase (TRK) fusions are involved in various adult and paediatric cancers, including thyroid cancers. There is a high mortality rate for some of these cancers, partly due to the lack of efficient detection, diagnosis, and prognosis.

The US and European guidelines recommend genomic testing as a part of standard diagnostic evaluations for some cancers to identify driver mutations for which effective therapies or clinical trials are available. However, adherence to genomic testing guidelines presents challenges to practitioners, including coordination of sample handling, long turnaround times, test reimbursement (in applicable settings), access to targeted therapies, insufficient tissue, and patient harm from the repeat biopsies necessary if the tissue sample is insufficient.

This episode offers some guidance around when and how to test for biomarkers of response to precision medicines. To answer our questions on the topic, we welcome the expertise of Professor Fernando López-Ríos. Professor López-Ríos is a pathologist at the ‘12 de Octubre’  University Hospital in Spain.

Funding Information:

This episode is supported by an educational grant from Eli Lilly, who have had no influence on the content or choice of faculty.

References

1. National Comprehensive Cancer Network. Thyroid Carcinoma. (Version 3.2021-October 15, 2021). Available at: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed January 16, 2022.

2. Belli C, et al. ESMO recommendations on the standard methods to detect RET fusions and mutations in daily practice and clinical research. Ann Oncol. 2021 Mar;32(3):337-350.

3. Marchiò C, et al. ESMO recommendations on the standard methods to detect NTRK fusions in daily practice and clinical research. Ann Oncol. 2019 Sep 1;30(9):1417-1427.

4. OncoKB: MSK's Precision Oncology Knowledge Base. Available at: https://www.oncokb.org/. Accessed March 15, 2022.

5. Mosele F, et al. Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group. Ann Oncol. 2020 Nov;31(11):1491-1505.