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A Review of the last evidence in treating older patients with cancer
A Discussion around your most challenging cases

The first SIOG USA Forum occurred on April 11, 2015 at the Moffitt Cancer Center in Tampa, Florida.  The goal of the full day Scientific Program was to raise awareness of Geriatric Oncology in the United States and lay the groundwork for future programs.

Topics included geriatric assessment and disease related topics including castrate resistant prostate cancer, chronic lymphocytic leukemia, non small cell lung cancer, melanoma and multiple myeloma.  There were also discussion of cases presentations and various aspects of the complexity of decision making in older cancer patients.  

Time Day Programme
07.30-08.00amRegistration/Continental Breakfast
08.00-08.15amWelcoming Remarks/ Introductions /SIOG Statement
Stuart Lichtman: Memorial-Sloan-Kettering Cancer Center, Commack (NY)
Lodovico Balducci: Moffitt Cancer Centre, Tampa (FL)  
08.15-08.45amState of Senior Oncology in the US; Geriatric Assessment (GA) and Related Strategies; Principals and Guidelines
Stuart Lichtman: Memorial-Sloan-Kettering Cancer Center, Commack (NY)
Oncology specific GA predictors: Chemotherapy Risk Assessment Scale for High-Age patients (CRASH) and Cancer and Aging Research Group (CARG); predictive value of geriatric assessment domains and recommendations to support vulnerable older patients through treatment; Appropriate chemotherapy dosing with end organ dysfunction, i.e. renal; Polypharmacy: strategies to minimize drug interactions and optimize compliance particularly with increased use of oral targeted agents; Supportive care during active treatment, ie. antiemetics, hematopoietic support; Decision making: adjuvant therapy; Palliative care.
08.45-09.15amAssessment of aging: from the bedside to the bench
Martine Extermann: Moffitt Cancer Center, Tampa (FL)
09.15-10.15amPromising Treatment Options in Castrate Resistant Prostate Cancer (CRPC) for the elderly: Update on Advancing Therapies
Supriya Mohile: University of Rochester Medical Center, School of Medicine and Dentistry, Rochester (NY)
Update on newer drugs for CRPC: enzalutamide, abiraterone, carbazeitaxel, radium 223; Decision making: estimated life expectancy and co-morbidity to determine optimal therapy; treatment of the asymptomatic patient with hormone sensitive metastatic prostate cancer and CRPC; Discuss new therapies with rational sequencing of these drugs; the potential of osteomimicry, exesome blockage, and stromal inhibition; Bone health issues and optimal management; Pain management
Your challenging cases being discussed
10.15-10.45amBreak
10.45am-12.15pm               Personalized treatment of CLL: we need the bench and the bedside. Advances in the Management of Chronic Lymphocytic Leukemia (CLL) and other B-Cell Malignancies
Kanti Rai: the Hofstra North Shore–LIJ School of Medicine and the North Shore–LIJ Cancer Institute — both in Lake Success (NY); and the Feinstein Institute for Medical Research, Manhasset (NY)
Overview of drivers of malignancy in the B-cell pathway and discussions illustrating best practices in the management of B-cell malignancies, including chronic lymphocytic lymphoma, mantle cell lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, and mucosa-associated lymphoid tissue lymphoma.
Your challenging cases being discussed
12.15-01.15pmLunch
01.15-01.45pmMelanoma and aging: how to deal with an incoming epidemics - Developing Treatment Strategies for Optimizing Outcomes
Jeff Weber: Moffitt Cancer Center, Tampa (FL)
Epidemiological, biological and molecular data suggesting that skin cancer is predominantly a disease of the elderly; Basel cell and squamous cell cancers; Changing nature of modern treatment cytokine-based immunotherapy, anti CTLA-4 antibody, therapy, BRAF, MEK inhibitor and PD-1 inhibitors; combination therapies. Basic epidemiology; Approved targeted drug's efficacy; Approved targeted drugs-toxicity specifically for elderly; Drug sequencing.
Your challenging cases being discussed
01.45-03.00pm

Evolving Targets and Treatment Paradigms in Multiple Myeloma: What Does it Mean for the Geriatric Patient
Hani Hassoun: Memorial Sloan Kettering Cancer Center, New York (NY)
Selection of evidence based induction regimens; Selection of older patients for bone marrow transplant; Maintenance therapy; New agents: carfilzomib and pomalidomide; Bone health issues; Co-morbidity into treatment decisions particularly renal insufficiency.
Your challenging cases being discussed

03.00-03.15pmBreak
03.15-04.15pmPersonalized Care of the Elderly with NSCLC: Evolving 2015 Update
Corey Langer: University of Pennsylvania, Philadelphia (PA)

Basic epidemiology and distribution of mutations Geriatric assessment in patient selection for surgery; Approved targeted drug's efficacy Combined modality therapy in older patients; Risks v. benefits of prophylactic cranial irradiation PCI (small cell); Use of mutation results in therapy selection; Front-line and maintenance therapy in metastatic disease; New and emerging agents; Role of co-morbidity in therapy selection; Palliative care.
Your challenging cases being discussed

04.15-04.45pmThe management of complexity: evidence-based or evidence-biased medicine? Beyond randomized controlled trials
Lodovico Balducci: Moffitt Cancer Centre, Tampa (FL)
04.45-05.00pmProgram Conclusion/Closing Remarks…Where do we go from here?
Stuart Lichtman: Memorial-Sloan-Kettering Cancer Center, Commack (NY)
Lodovico Balducci: Moffitt Cancer Centre, Tampa (FL)
Panel of speakers + participation of audience

A Review of the last evidence in treating older patients with cancer
A Discussion around your most challenging cases

Lodovico Balducci - Moffitt Cancer Centre, Tampa (FL)

 Lodovico Balducci is Program Leader of the Senior Adult Oncology Program and Medical Director of Affiliates & Referring Physician Relations at H. Lee Moffitt Cancer Center & Research Institute, and Professor of Oncologic Sciences, University of South Florida College of Medicine, in Tampa, Florida. Dr. Balducci received his medical degree from Catholic University, Rome, Italy, and his residency training and fellowship at the University of Mississippi Medical Center, in Jackson, Mississippi.

Dr. Balducci has edited five textbooks on geriatric oncology and two books on geriatric hematology. Dr. Balducci has published over 250 articles in various medical journals on the subject of geriatric oncology, and five monographs on geriatric oncology. Dr. Balducci’s clinical research activities include cancer and aging, management of the frail elderly, assessment of quality of life in the older cancer patient, prognostic assessment of the older cancer patient, and interactions of comorbidity and function in the older cancer patient. Dr. Balducci was a member of ASCO’s Grant Selection Committee, and ASCO’s Cancer & Aging Task Force and Oncology Workforce Task Force. Dr Balducci is Editor-in-Chief of Cancer Control Journal at Moffitt Cancer Center. In 2003, Dr. Balducci was selected to present the first Paul Calabresi Memorial Lecture by the International Society of Geriatric Oncology (SIOG) in Rome, Italy.

In 2003, he also received the ACCC award for Outstanding Achievement in Clinical Research, and was the 2003 Physician of the Year recipient at the Moffitt Cancer Center. In 2007, he received the Medi Tavossoli Lecture Award for Innovative Research in Hematology in the Elderly and the ASCO’s B.J. Kennedy Award and Lecture for Scientific Excellence. In 2009, he received the 17th Claude Jacquillat Award in Paris and was also the recipient of the 2009 Nimmo Visiting Professorship in Adelaide, Australia. In 2014, he received the Fifth Annual Enzo Piccinini Prize in Italy.

Dr. Balducci is board certified in Medical Oncology/Hematology. He is a member of the American Geriatrics Society, the American Society of Clinical Oncology, American Association for Cancer Research, American Society of Hematology, American Society of Breast Disease, and a fellow of the American College of Physicians. Dr. Balducci has lectured throughout the USA, Europe, Asia, Australia and South America.

 

Martine Extermann - Moffitt Cancer Center, Tampa (FL)

 Dr. Martine Extermann is Professor of Oncology and Medicine at the University of South Florida. She is a Senior Member in the Senior Adult Oncology Program at the Moffitt Cancer Center. She earned her medical diploma and her medical PhD at the University of Geneva, Switzerland. She has a Swiss Board Certification in Internal Medicine, specialty Oncology-Hematology. She also holds ABIM certifications in Internal Medicine and Medical Oncology. She has worked at Moffitt since 1994 and has been a faculty member since 1997. Her research focuses on cancer in the elderly. Her main areas of investigation are comorbidity, comprehensive assessment, and prediction/prevention of treatment toxicity in older cancer patients.

She served as Chair of the Eastern Cooperative Oncology Group’s Subcommittee on Aging and is presently involved in the South West Oncology Group. She also served as President of the International Society of Geriatric Oncology (SIOG), of which she is also a founding board member. She served on the ASCO Education and Scientific Program Committees, and is an Editorial Board member of the Journal of Clinical Oncology. Dr. Extermann was presented at ASCO 2009 with the B.J. Kennedy Award for Scientific Excellence in Geriatric Oncology.

 

Hani Hassoun - Memorial Sloan Kettering Cancer Center, New York (NY)

I am a board-certified hematologist/oncologist with a special interest in plasma cell dyscrasias — a group of disorders that includes multiple myeloma, amyloidosis, light chain deposition disease, POEMS syndrome, and Waldenström’s macroglobulinemia. There have been tremendous advances in this field over the past decade, and several new drugs are available or in development to manage these conditions. With my colleagues at Memorial Sloan Kettering Cancer Center, I have focused on developing and optimizing new approaches to treat these diseases, including both new drugs and new strategies to improve patients’ outcomes. In multiple myeloma we currently have several clinical trials that are addressing important questions in patients who are newly diagnosed and have never been treated to better define the role and timing of autologous stem cell transplantation. We are also conducting several clinical trials in patients whose disease has recurred after initial treatment in order to develop new drugs that would be effective against the disease. Likewise, in the field of amyloidosis and light chain deposition disease, we are currently testing the role of a comprehensive treatment that incorporates autologous stem cell transplantation preceded and followed by more conventional therapies. We are hopeful that this comprehensive treatment will allow optimal control of the disease. I also have a particular interest in thrombotic complications (blood clotting) that occur in cancer patients and in patients receiving chemotherapy. We are trying to develop prophylactic strategies to decrease the frequency of these common complications in cancer patients using old and newer blood thinners.

Corey Langer - University of Pennsylvania, Philadelphia (PA) 

Corey J. Langer, MD, FACP is Professor of Medicine in the Hematology/Oncology Division at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania, where he serves as Director of Thoracic Oncology in the Abramson Cancer Center. Dr Langer received his medical degree from Boston University in Boston, Massachusetts in 1981 and completed his internship and residency in medicine at the Graduate Hospital of the University of Pennsylvania in Philadelphia, Pennsylvania. Additional postgraduate training included a fellowship in hematology/oncology at the Penn Presbyterian Medical Center and a fellowship in oncology at AOH/Fox Chase Cancer Center (FCCC). He is board certified in internal medicine and in hematology/oncology.

Dr Langer served in the oncology division of Fox Chase Cancer Center [FCCC] for 22 years from 1986 until 2008, and for the last 14 years of his tenure at FCCC, he led its Thoracic Oncology Program. He also served as the research chair of Oncology Physicians Network, a consortium of academic and community facilities in the Delaware Valley allied with FCCC. In June of 2008, he moved to the University of Pennsylvania where he currently leads the Interdisciplinary Thoracic Oncology Program (I-TOP).

Dr Langer is a fellow of the American College of Physicians and is a member of the American Society of Clinical Oncology (ASCO), the American Association for Cancer Research (AACR), the International Association for the Study of Lung Cancer (IASLC), and the Society of Head and Neck Surgeons. He has served as Vice-Chair of the Radiation Therapy Oncology Group (RTOG, now NRG) and chairs its Medical Oncology Subcommittee. He also serves on the core Thoracic and Head and Neck Committees of both the Eastern Cooperative Oncology Group (ECOG) and RTOG (NRG).

Dr Langer has contributed numerous articles (>170) and abstracts (>200) to the medical literature. His work on head and neck squamous cell cancer and non-small cell lung cancer has appeared in the New England Journal of Medicine, Seminars in Oncology, Clinical Cancer Research, Journal of Clinical Oncology, Journal of Thoracic Oncology, Clinical Lung Cancer, Cancer, Lung Cancer, Cancer Investigation, and EJC. His work has also been presented at the national meetings of ASCO, AACR, ASH, and the IASLC. He has served three separate terms as a member of the editorial board of the Journal of Clinical Oncology, and is currently on the editorial boards of Clinical Lung Cancer and Clinical Advances in Hematology and Oncology. Dr Langer was also a member of PDQ editorial board/National Cancer Institute protocol submissions and while at FCCC, he served on the NCCN NSCLC and SCLC committees. He reviews articles for the New England Journal of Medicine, Journal of Clinical Oncology, Clinical Lung Cancer, Clinical Cancer Research, Cancer, Annals of Oncology, Lung Cancer, and the Journal of Thoracic Oncology. He is also a frequent lecturer at numerous medical symposia and grand rounds and serves as advisor/commentator for Projects in Knowledge, Impact, and Medscape.

Finally, he is the Immediate Past President of Delaware Valley Poets, which holds monthly workshops in Mercer County, NJ and monthly readings at the Princeton Public Library. He and his wife Mindy, a retired pediatrician, live in Princeton Jcn, NJ. His daughter Adina is a historian, who previously worked for the World Trade Center Memorial Foundation in NYC and is now an Adjunct Professor in History at Georgia State; she and her husband Matt are the proud parents of Corey’s grandson, Leo Gabriel DeAngelis. Corey’s son Micah is a classical saxophonist with a degree from McGill University in Montreal, where he currently resides.

 

Stuart Lichtman - Memorial-Sloan-Kettering Cancer Center, Commack (NY)

Dr. Lichtman is a graduate of the Mount Sinai School of Medicine and is an Attending Physician at Memorial Sloan Kettering Cancer Center and Professor of Medicine, Weill Cornell Medical College. He is a medical oncologist who is a member of the Gynecologic Oncology Disease Management Team. His primary research interest in the treatment of older patients with cancer and is a member of the Center's 65+ Clinical Geriatrics Program.

Dr. Lichtman is involved in a number of research organizations including the Elderly Taskforce of the Gynecologic Oncology Group, the Gynecologic Cancer Steering Committee of the National Cancer Institute and the Cancer in the Elderly committee of the Alliance for Clinical Trials in Oncology. He has been on the Board of Directors and served as Treasurer of the International Society of Geriatric Oncology (SIOG) and has participated in multiple taskforces (Chemotherapy, Geriatric Assessment, Renal Dysfunction, Lymphoma, and Oral Chemotherapy) and as the US National Representative and Scientific Chair of the 2011 annual meeting.

He also serves on the editorial board of the Journal of Geriatric Oncology, External Advisory Board of the University of Iowa Cancer Center, Governing Board Cancer and the Kidney International Network. As a member of the American Society of Clinical Oncology (ASCO), he has been on the Clinical Practice Committee and Scientific Program Committee and currently on the Geriatric Oncology Special Interest Group. He has been a guest editor for the Journal of Clinical Oncology on a special edition devoted to geriatric oncology in 2007 and 2014. Also in 2014, he received the ASCO BJ Kennedy Award for Scientific Excellence in Geriatric Oncology and is the President-Elect of SIOG.

 

Supriya Mohile - University of Rochester Medical Center, School of Medicine and Dentistry, Rochester (NY)

Supriya Gupta Mohile, M.D., M.S. is a board-certified geriatrician and oncologist. Dr. Mohile has developed a clinical and research program in geriatric oncology by strengthening the links between geriatrics and oncology. A graduate of Pennsylvania State University, she earned her M.D. at Thomas Jefferson Medical School. She completed internship, residency and fellowships in hematology/oncology and geriatrics at University of Chicago Medical Center, where she also earned a Master's degree in health outcomes research. Mohile's fellowship was funded by an American Society of Clinical Oncology and John Hartford Foundation initiative to train oncologists in the care of the elderly.

Mohile's research interests include the evaluation of patterns of care, health outcomes, and quality of life related to treatment for systemic cancer in older patients. She has previously received an American Society of Clinical Oncology Young Investigator Award and Merit Awards. Mohile was a Hartford Geriatrics Health Outcomes Research Scholar sponsored by the American Geriatrics Society and was a Clinical and Translational Science Institute K-L2 Awardee. In 2013, she was awarded a Patient Centered Outcomes Research Institute Award and a NCI R01 to evaluate whether geriatric assessment can improve outcomes of older patients with cancer. She directs the Specialized Oncology Care & Research in the Elderly (SOCARE) geriatric oncology clinic at the University of Rochester/Highland Hospital.

She also Chairs the Cancer Care Delivery Research Program through the University of Rochester NCORP Research Base which is directed by Dr. Gary Morrow. She is an expert in geriatric oncology with over 85 publications in this area. She serves on the editorial board of the Journal of Clinical Oncology and is Associate Editor of the Journal of Geriatric Oncology. She also serves on the American Society of Clinical Oncology Geriatric Oncology Exploration and Clinical Guidelines committees.

 

Kanti R Rai - the Hofstra North Shore–LIJ School of Medicine and the North Shore–LIJ Cancer Institute — both in Lake Success (NY); and the Feinstein Institute for Medical Research, Manhasset (NY) 

Kanti R. Rai, MD was born in Jodhpur, India and received his medical education in Jaipur, India. After residency training in pediatrics and Fellowship in hematology and nuclear medicine in hospitals in New York, he joined the hematopoietic cell-kinetic research team led by Dr. Eugene Cronkite at the Brookhaven National Laboratory in Upton, N.Y.

Interest in the study of lymphocyte biology and in chronic lymphocytic leukemia (CLL) soon followed in the early 1960’s, with collaboration with his two mentors, Dr. Cronkite and Dr. Arthur Sawitsky. This collaboration led to the development of the system of clinical staging of CLL. Dr. Rai has continued to remain in the forefront of research in the studies of natural history of CLL, improving prognostic features and in the development of newer strategies of therapy which are hypothesis-driven. Dr. Rai is an active investigator in the Chronic Lymphocytic Leukemia Consortium (CRC), the International Workshop on CLL (IWCLL) and Cancer and Leukemia Group B (CALGB).

He is a member of the American Society of Clinical Oncology (ASCO), American Association for Cancer Research (AACR) and the American Society of Hematology (ASH). In 2006, Dr. Rai served as the President of ASH. He was the recipient of ASCO’s David Karnofsky Memorial Award in 2012. He is the Joel Finkelstein Cancer Foundation Professor of Medicine, and Professor of Molecular Medicine at the Hofstra North Shore-LIJ School of Medicine and Chief, CLL Research & Treatment Program, North Shore LIJ Health System in New Hyde Park, NY.

 

Jeff Weber - Moffitt Cancer Center, Tampa (FL)

Dr. Weber earned his Ph.D. in molecular cell biology from Rockefeller University (New York) in 1979 and received his M.D. from New York University in 1980. He completed his internship and residency in Medicine at the University of California, San Diego, and his fellowship in Medical Oncology at the National Cancer Institute in Bethesda, MD.

His experience includes clinical, research and teaching positions at the University of California, Irvine, and the University of Southern California where he was Chief of Medical Oncology and Associate Director for Clinical Research at the USC/Norris Comprehensive Cancer Center. Coming to Moffitt in 2007, Dr. Weber is a Senior Member, Director of the Donald A. Adam Comprehensive Melanoma Research Center, and Professor in the Department of Oncologic Sciences.

A specialist in cancer immunotherapy, Dr. Weber is principal investigator (PI) on several ongoing studies funded by the National Cancer Institute (NCI), including trials in clinical drug development, vaccines, and studies on autoimmunity and melanoma. He has been continuously NCI R01 funded for the last 16 years. Dr. Weber is also the Principal Investigator and Director of the Moffitt Skin Cancer SPORE (P50) NCI grant, a collaborative, multi-project translational research program. Dr. Weber has published more than 100 articles in the top peer-reviewed journals in his field including New England Journal of Medicine, Clinical Cancer Research, Journal of Clinical Oncology and Nature Medicine. Dr. Weber sat on the National Cancer Institute’s Clinical Oncology Study section as well as the boards of the Melanoma Research Foundation and the Melanoma Therapeutics Foundation, and served as a chair of the Veterans Administration’s clinical oncology study section. He currently sits on the scientific advisory boards of four cancer-related biotechnology companies.

Dr. Weber’s research interests are in the field of immunotherapy for cancer. As a translational clinical investigator, Dr. Weber has performed a variety of vaccine trials, protocols involving adoptive cell therapy, and novel immunotherapy trials in melanoma patients. His specific laboratory interests are in the monitoring and characterization of T cell responses in patients with cancer, and the establishment of in vitro models to facilitate the understanding of how immune modulation via abrogating and activating antibodies amplifies adaptive immunity in patients. Clinically, he has held 10 investigator-initiated IND over the last decade, and has pursued cutting edge trials recently using gene modified dendritic cells, intranodal injection of plasmid-peptide priming and boosting and novel antibodies like CTLA-4 and PD-1 abrogating antibodies. He has been a pioneer in the clinical advancement of antibodies that induce autoimmunity as a surrogate for clinical benefit in cancer, and the management of the autoimmune side effects.

SIOG wishes to express its appreciations for the support of the following educational partners:

Moffitt Cancer Center is a not-for-profit institution, located on the campus of the University of South Florida. Moffitt is the only cancer center in Florida recognized as a NCI-designated Comprehensive Cancer Center. Today, Moffitt’s laboratories and clinics comprise more than two million square feet of cancer facilities dedicated to patient care, research and education. At Moffitt Cancer Center, our mission is to contribute to the prevention and cure of cancer. Considered to be one of the fastest-growing cancer centers in the United States, Moffitt is the only Florida-based National Cancer Institute-designated Comprehensive Cancer Center, one of only 41 in the nation focused on cutting-edge research and treatment.

 

The University of Nebraska Medical Center/Center for Continuing Education (UNMC/CCE) is accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME) and is one of this country’s oldest accredited providers of continuing education for physicians. UNMC/CCE is dedicated to lifelong learning through the promotion and delivery of educational programs for healthcare professionals while striving to provide high quality educational opportunities for healthcare professionals. The Center offers a broad range of programming (i.e., live activities, conferences, workshops, as well as, self-directed learning activities/enduring materials) with content ranging from primary care issues to the latest developments in oncology, as well as, other specialties that are premier to the institution. UNMC/CCE sponsors nearly 800 activities annually that reach approximately 50,000 healthcare providers and draws attendees from throughout the region, nation and internationally.

 

Plexus Communications is dedicated to systematically assessing and measuring both the anticipated and real effects of our educational programming, designed to improve healthcare provider knowledge, competency, and performance with the ultimate goal of achieving better patient outcomes. We have extensive experience in educating oncologists/hematologists, pathologists, nurses, and pharmacists, delivering programs to over 30,000 certificate issued learners. PleXus has accomplished this by developing the Topics in Oncology/Hematology Expert Clinical Exchange Forums (live hospital based oncology/hematology rounds) and conducting satellite symposia at the Society of Urologic Oncology (SUO), American Society of Clinical Oncology (ASCO), American Society of Clinical Pathologists (ASCP), American Society for Radiation Oncology, American Society of Health-System Pharmacists (ASHP) and several other national conferences. We have developed an extensive network of hospitals around the country that rely on PleXus for continuing education for their oncology/hematology staff. Additionally, we have published supplements in a variety of oncology/hematology journals including Community Oncology, Supportive Care Oncology, Oncology Pharmacist, Formulary, and US Pharmacist. We have also developed enduring activities hosted by Medscape, Epocrates Mobile CME, Peer Audience, as well as the PleXus Communication home site.
 
We gratefully acknowledge educational grant support from Janssen Scientific Affairs, LLC and Onyx Pharmaceuticals.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the University of Nebraska Medical Center, Center for Continuing Education, Plexus Communications and SIOG.

The University of Nebraska Medical Center, Center for Continuing Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The University of Nebraska Medical Center, Center for Continuing Education designates this live activity for a maximum of 7.25 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.