TARGET AUDIENCE
This activity is intended for medical oncologists, hematologist-oncologists, hematology-oncology fellows, oncology nurses, radiation oncologists, colorectal-general surgeons and other healthcare practitioners involved in the management of colorectal cancer.

OVERVIEW OF ACTIVITY
Cancer of the colon and rectum is the fourth most frequently diagnosed cancer and the second most common cause of death among all neoplasms in the United States, accounting for approximately 9% of all cancer deaths. It is estimated that 102,480 new cases of colon cancer and 40,340 new cases of rectal cancer will be diagnosed in the United States in 2013. Among the 39% of colorectal cancer cases found in the localized setting, 5-year survival rates approach 90% with current therapeutic interventions. However, for the remaining patients diagnosed with regionally advanced or de novo metastatic disease, this statistic declines to 70% and 11%, respectively. Thus, early detection and aggressive intervention hold the potential for improvement in outcomes.

Current therapeutic management of colorectal cancer is dependent on tumor stage at the time of initial diagnosis, status of surgical margins (R0, R1, R2), patient performance status, age, prior treatment exposure and sites of metastasis for those with disease recurrence or de novo advanced cancer. Although these variables are helpful in guiding selection of treatment, the introduction of novel biomarkers, multigene signatures and molecular-targeted systemic agents has significantly refined the clinical algorithm such that individualized therapeutic approaches have become the standard. This rapid paradigm shift presents a challenge to practicing oncologists who must grapple with the presentation of ambiguous data sets and their immediate impact on treatment decisions.

To bridge the gap between research and patient care, this CME activity will use the perspectives of clinical investigators on key management challenges and controversies in colorectal cancer to assist medical oncologists, hematologist-oncologists, hematology-oncology fellows, colorectal-general surgeons and other cancer clinicians in the formulation of up-to-date and appropriate treatment strategies.

LEARNING OBJECTIVES

• Consider the clinical decision-making of investigators with expertise in the management of colorectal cancer, and use this information to potentially alter future late-line therapeutic strategies for patients with metastatic disease.
• Recall the optimal starting dose of regorafenib used by clinical investigators for appropriately selected patients with metastatic colorectal cancer.
• Evaluate the impact of patient age on the regorafenib dose selected by clinical investigators for patients who have received extensive prior treatment for metastatic colorectal cancer.
• Assess the course of action taken by clinical investigators in the management of hand-foot syndrome experienced by patients receiving regorafenib for metastatic colorectal cancer.

ACCREDITATION STATEMENT
Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME credit is no longer available for this issue

CREDIT DESIGNATION STATEMENT

CME credit is no longer available for this issue

HOW TO USE THIS CME ACTIVITY
This CME activity consists of a text component. The participant should review the treatment preference matrix.

CME credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES
Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CME activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

Steven R Alberts, MD, MPH
Chair, Division of Medical Oncology
Professor of Oncology
Mayo Clinic
Rochester, Minnesota

No real or apparent conflicts of interest to disclose.

Al B Benson III, MD
Professor of Medicine
Associate Director for Clinical Investigations
Robert H Lurie Comprehensive Cancer Center of Northwestern University
Chicago, Illinois

Advisory Committee: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Genentech BioOncology, Genomic Health Inc, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Lilly, Precision Therapeutics Inc, Sanofi, Spectrum Pharmaceuticals Inc; Contracted Research: Amgen Inc, Astellas, Genentech BioOncology, Gilead Sciences Inc, Novartis Pharmaceuticals Corporation.

Charles S Fuchs, MD, MPH
Director, Center for Gastrointestinal Cancer
Dana-Farber/Harvard Cancer Center
Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Advisory Committee: Celgene Corporation, Genentech BioOncology, Lilly, Metamark Genetics Inc, Sanofi, Takeda Pharmaceuticals North America Inc; Consulting Agreements: ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Lilly.

Richard M Goldberg, MD
Professor of Medicine
Physician-in-Chief, OSUCCC - James Cancer Hospital and Richard J Solove Research Institute
Klotz Family Chair in Cancer Research
The Ohio State University
Columbus, Ohio

Advisory Committee: Sanofi; Consulting Agreements: Lilly, Pfizer Inc; Contracted Research: Bayer HealthCare Pharmaceuticals, Sanofi; Speakers Bureau: Fresenius Kabi AG, Yakult Pharmaceutical Industry CO LTD.

Axel Grothey, MD
Professor of Oncology
Department of Medical Oncology
Mayo Clinic
Rochester, Minnesota

Contracted Research: Bayer HealthCare Pharmaceuticals, Eisai Inc, Genentech BioOncology, Lilly.

Howard S Hochster, MD
Associate Director (Clinical Research)
Yale Cancer Center
Professor of Medicine, Yale School of Medicine
New Haven, Connecticut

Advisory Committee: Genentech BioOncology, Genomic Health Inc, Roche Laboratories Inc, Sanofi; Speakers Bureau: Genomic Health Inc.

Herbert I Hurwitz, MD
Associate Professor of Medicine
Division of Hematology/Oncology
Clinical Director, Phase I Program
Co-leader, GI Oncology Program
Duke University Medical Center
Durham, North Carolina

Consulting Agreements: Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, EMD Serono Inc, Genentech BioOncology, GlaxoSmithKline, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Lilly, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc, Sanofi; Contracted Research: Abbott Laboratories, Genentech BioOncology, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc, Sanofi.

Wells A Messersmith, MD
Professor and Director
GI Medical Oncology Program
Co-Leader
Developmental Therapeutics Program
University of Colorado Cancer Center
Aurora, Colorado

Contracted Research: Genentech BioOncology, GlaxoSmithKline, Millennium: The Takeda Oncology Company, Pfizer Inc, Roche Laboratories Inc; Data and Safety Monitoring Committee: GlaxoSmithKline, Morphotek Inc.

EDITOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Algeta US, Allos Therapeutics, Amgen Inc, ArQule Inc, Astellas, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, EMD Serono Inc, Exelixis Inc, Foundation Medicine Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc and Teva Oncology.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Bayer HealthCare Pharmaceuticals, Genentech BioOncology, Genomic Health Inc and Lilly.

Hardware/Software Requirements:
A high-speed Internet connection
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
Adobe Flash Player 10.2 plug-in or later
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio

Last review date: October 2013
Expiration date: October 2014