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Elderly and poor–performance status (PS) patients represent a significant proportion (approximately 40%-50%) of patients with advanced non–small-cell lung cancer (NSCLC). The standards of care for these subsets of patients are not clearly defined since they are regularly excluded from clinical trials due to the assumption that they would experience increased toxicity with chemotherapy. In recent years, clinical trials conducted specifically for elderly and poor-PS patients have provided some insight into treatment recommendations for these patients. Analysis of PS 2 patients in Cooperative Group trials has shown significant benefit from first-line chemotherapy, with overall toxicity rates generally similar to those seen in PS 0/1 patients. Platinum and non-platinum regimens and single-agent chemotherapy have been compared. Different doses and schedules of first-line chemotherapy have been assessed in this select population. Elderly patients who do not have significant comorbid conditions respond to and tolerate doublet chemotherapy just as well as younger patients. For second-line therapy of advanced NSCLC, currently approved regimens include taxanes, antifolates, and small-molecule epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). Although clinical data on targeted agents in this distinct population of patients with advanced NSCLC are currently limited, several trials of EGFR TKIs in elderly patients are under way.

The purpose of this activity is to review the standards of care for elderly and poor-PS patients with advanced NSCLC.

• Discuss options for the first- and second-line treatment of elderly and poor-PS patients with stage IIIB/IV NSCLC
• Compare single-agent chemotherapy or an EGFR inhibitor to platinum-based doublet chemotherapy as first-line treatment of PS 2 patients with advanced NSCLC
• Evaluate options for the second-line treatment of advanced NSCLC, including single-agent chemotherapy and EGFR TKIs

Physicians’ Education Resource designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Physicians’ Education Resource to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Physicians’ Education Resource requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Physicians’ Education Resource has implemented a mechanism to identify and resolve all conflicts of interest prior to the activity.

Howard “Jack” West, MD
Paid Consultant – AstraZeneca, Genentech BioOncology, OSI Pharmaceuticals

Mark A. Socinski, MD
Grant or Research Support – Amgen, AstraZeneca, Bristol-Myers Squibb, Lilly Oncology, sanofi-aventis
Speaker’s Bureau – Amgen, AstraZeneca, Bristol-Myers Squibb, Lilly Oncology, sanofi-aventis

Corey Langer, MD, FACP
Research Funding – Active Biotech; Amgen; AstraZeneca; Bristol-Myers Squibb; Celgene; Cell Therapeutics, Inc.; Genentech BioOncology; Lilly Oncology; Medimmune Inc.; Ortho Biotech Products, L.P.; OSI Pharmaceuticals; Pfizer Oncology; sanofi-aventis; Schering-Plough; Vertex Pharmaceuticals Incorporated
Paid Consultant – Abraxis BioScience; Amgen; AstraZeneca; Bayer HealthCare Pharmaceuticals/Onyx Pharmaceuticals, Inc.; Bristol-Myers Squibb; Genentech BioOncology; GlaxoSmithKline Oncology; ImClone Systems; Intrabiotics; Millennium Pharmaceuticals; Novartis Oncology; OSI Pharmaceuticals; Pfizer Oncology; Pharmacyclics; sanofi-aventis; Savient
Speaker’s Bureau – Bristol-Myers Squibb; Genentech BioOncology; Lilly Oncology; Ortho Biotech Products, L.P.; sanofi-aventis

Nasser Hanna, MD
Research Funding – Bristol-Myers Squibb

PER Editorial Staff
No relevant relationships to disclose

This CME activity might include discussion of investigational and/or unlabeled uses of drugs. If the activity includes discussion of investigational and/or unlabeled uses of a drug, it is noted. Please refer to the full prescribing information for each drug discussed in this activity for FDA-approved dosing, indications, and warnings.

The views and opinions expressed in this activity are those of the authors and do not necessarily reflect the views of the sponsor, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this activity to ensure accuracy, the authors, Physicians’ Education Resource and its servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this activity, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

Please consult full prescribing information for any drugs or procedures discussed within.

All rights reserved. No part of this activity may be translated, reproduced, stored, or transmitted by any means or in any type of media form including electronic, mechanical photocopying, recording, broadcasting, or otherwise without prior permission from the publisher.

©Copyright 2007 by Physicians’ Education Resource. No material may be reproduced in whole or in part, in any form, without written permission from the publisher.

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