Expiration Statement

ACCREDITATION FOR THIS ACTIVITY HAS EXPIRED

Educational Centre Title

Current Clinical Problems in Bladder Cancer

Activity Four Title

How to Treat Bladder Cancer When BCG is Unavailable

- Prof. Fred Witjes

Program Goals

When dealing with patients with non muscle-invasive bladder cancer (NMIBC) know the different risk profiles and what that means for treatment choice (AUA and EAU guideline). This means that BCG shortage or unavailability is an issue in intermediate and high risk disease. In intermediate risk we can safely use one year of chemotherapy as alternative. This means a slightly increased recurrence rate, but not more progression.

In the higher end of the intermediate disease and high risk disease BCG is an issue. Beware that the alternatives for BCG unavailability will overlap with the alternatives for BCG non responsive disease, as discussed by Dr Kamat.

What are some conclusions in case of high risk disease and BCG shortage? Prediction of response is not ready yet for use in daily practice. A less intense BCG schedule can be used safely, so consider reduction of the number of instillations per course (omit the last one), the treatment time (1 instead of 3 years) and the dose (1/3 dose). Finally, combination / sequential therapy does not seem the answer in high grade Ta disease.

What can we conclude in case of BCG unavailability? In high risk patients intravesical chemo or combination therapy does not seem to be a solid answer. Other immunotherapies were/are interesting, but need revitalization or further studies. Device assisted therapies (especially radiofrequency (RF) induced hyperthermia) certainly is an option. The future, however, looks bright since new strategies and drugs are being explored. Finally, a radical cystectomy does not seem to be the first choice for high grade Ta in case there is no BCG.

Target Audience

This activity is intended for medical professionals who have a clinical interest in the management of bladder cancer: urologists, medical oncologists and radiation oncologists as well as primary care physicians, advanced Practice Nurses, Nurse Practitioners, Physicians Assistants, Managed Care Medical Directors, and other Practitioners and Payers.

Learning Objectives

Readers who engage with this educational publication will be able to:

1. Define the different risk categories of non muscle-invasive bladder cancer (NMIBC) from guidelines.
2. Identify which therapy is advised in each risk category by the guidelines.
3. Distinguish the different approaches in case of BCG shortage or BCG unavailability.
4. Explain the different approaches and their consequences in case of intermediate risk disease and high risk disease when there is any kind of BCH issue.

Faculty

Educational Activity Agenda

Understanding the spectrum of tumors after BCG failure

• Front Matter and Registration (3 minutes)
  
• Faculty Introduction, Presentations and Roundtable Discussions (59 minutes)
• Post Test, Evaluation, and Credit Application (6 minutes)

Release and Expiration Dates

Enduring Archive Release Date: December 6, 2017
Enduring Archive Expiration Date: Expired December 6, 2019

Disclosure of Conflicts of Interests

Global Education Group requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

Faculty Disclosures

The faculty reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

H. Barton Grossman, MD

• Consultant / independent Contractor: Nucleix and Cephied
• Royalty: University of Michigan (Bladder Cancer Cell Lines licensed to Array BioPharma, Halozyme, and Regeneron Pharmaceuticals)

Ashish M. Kamat, MD

• Consultant: Photocure; Telesta Therapeutics; Sanofi; Merck; Abboth Molecular; Theralase; Heat Biologics; Spectrum Pharmaceuticals; Oncogenix
• Grant/Research Support: FKD Industries; Photocure; Merck; Heat Biologics

 Maximilian Burger, MD

• Consultant: Ipsen, Astellas, Pfizer, BMS, Takeda
• Speaker's Bureau: Janssen, Astellas, Pfizer, Medac, Takeda

 Yair Lotan, MD

• Consultant: Pacific Edge, MDxHealth, Photocure, Cepheid
• Grant/Research Support: Abbott, Pacific Edge, MDxHealth, Photocure, Cepheid

Fred Witjes, MD

• Consultant: MEL (Synergo), Sanofi Pasteur, Spectrum and Taris

Arnulf Stenzl, MD

• Nothing to Disclose

Sharokh Shariat, MD

• Grant/Research Support: BMS, Roche, Sanofi, Jansen, Astellas, AstraZeneca, Bayer
• Honoraria: BMS, Cepheid, IPSEN, Jansen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Sanochemia, Sanofi, Wolff
• Speaker's Bureau: BMS, Cepheid, IPSEN, Jansen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Roche, Sanochemia, Sanofi, Wolff 

James Catto, MD

• Nothing to Disclose

Planners and Managers

The planners and managers reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Ashley Marostica, RN, MSN

• Nothing to disclose

Lindsay Borvansky

• Nothing to disclose

Andrea Funk

• Nothing to disclose

Liddy Knight

• Nothing to disclose

CME Provider Accreditation Statement

This activity is provided by Global Education Group.     

Physician Accreditation Statement - CME

Global Education Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. 

*This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation - CME

Global Education Group designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 1561024. This activity is approved for 1.0 contact hour(s) which includes 0.75 hour(s) of pharmacology.

Activity ID 2341E. This activity was planned in accordance with AANP CE Standards and Policies.

UEMS and AMA CME Credit Reciprocity

The European Union of Medical Specialties (UEMS) has an agreement of mutual recognition of continuing medical education (CME) credit with The American Medical Association (AMA). Under the terms of this agreement, the European Accreditation Council for Continuing Medical Education (EACCME) will accept AMA Category 1 Credit™ CME credit for live and e-learning activities.

Global Education Group

For information about the physician accreditation for this activity, please contact Global Education Group at (303) 395-1782, or cme@globaleducationgroup.com.

How to Obtain CME/CE Credit

Attendees are expected to view all presentations before attempting to take the test and/or complete the activity evaluation. Successful completion will lead to the issuance of a certificate for AMA PRA Category 1 Credits™ or nursing credits. To receive credit, the course must be completed between December 6, 2017 and is now expired December 6, 2019.

Participation in this activity should be completed in approximately 1.0 hours. Please follow these steps in order to receive CME/CE credit for viewing the webcast:

• Read all of the CME/CE accreditation information above.
• View the complete electronic (web) activity.
• Click on the link to apply for CME/CE credits.
• Complete the online registration (registration is free).
• Complete the online test and/or evaluation. Participants must receive a test score of at least 75% and answer all evaluation questions to receive a certificate.

After successfully completing the online test and/or evaluation, your application will be immediately processed and you will be given the opportunity to download a personalized CME/CE certificate for participation in this activity. 

Should you have any CME/CE questions regarding this activity, please contact:

Global Education Group
5575 S. Sycamore Street, Suite 200
Littleton, CO 80120
Phone: 303-395-1782
Fax: 303-648-5311
Email: cme@globaleducationgroup.com
Web: www.globaleducationgroup.com

Fee Information

There is no fee for this educational activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) does not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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Global Education Group protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. Global Education Group and our joint sponsors will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

Global Education Group, and its educational partners maintain physical, electronic and procedural safeguards that comply with recognized accreditation regulations to guard your non-public personal information.

Medium Used

This program has been made available online.
"How to Treat Bladder Cancer When BCG is Unavailable"

System Requirements

To view this educational activity you will need a web browser with Javascript and either Flash or HTML5 enabled.  Nearly all modern web browsers will work.

Commercial Support Statement

This online Educational Centre is supported by an Educational Grant from Cephied Inc. and Photocure.

Copyright

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