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    Faculty & Disclosures
    Dr Reetu Mukherji

    MedStar Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA

    Dr Reetu Mukherji is an assistant professor of medicine within the Division of Hematology and Oncology at MedStar Georgetown Lombardi Comprehensive Cancer Center in Washington DC, USA. read more

    Dr Mukherji received her MD from the Lewis Katz School of Medicine at Temple University in Philadelphia, PA, completed her internal medicine residency at Thomas Jefferson University Hospital, and completed her haematology and oncology fellowship at MedStar Georgetown University Hospital. She is board certified in internal medicine, haematology and medical oncology.

    Dr Mukherji is a medical oncologist specializing in the treatment of gastrointestinal (GI) cancers. Her research interests involve GI cancers, novel drug development, predictive and prognostic genomic biomarkers, circulating tumour DNA and circulating tumour cells. She has published in several peer-reviewed journals, including the Journal of Clinical Oncology, on the role of immunotherapies, applications of prognostic genomic biomarkers, and applications of liquid biopsies in the management of patients with GI malignancies. She is a member of the American Society of Clinical Oncology.

    Dr Mukherji discloses

    Grants/research support from Genentech and Natera.
    Dr Jaffer Ajani

    Houston, TX, USA

    Dr Jaffer Ajani is a professor of medicine at a cancer centre in Houston, TX, USA. read more

    He received his doctor of medicine from Government Medical College, Nagpur, India. He is interested in upper gastrointestinal (GI) cancer research and focuses on combined modality trials for gastric and esophageal cancers. Dr Ajani has led numerous phase II and III randomized trials, has participated in cooperative groups and has participated actively in the International Society of Gastrointestinal Oncology (ISGIO).

    Dr Ajani has significant expertise in coordinating multidisciplinary research in gastric and esophageal cancers, and has over 30 years of experience leading investigator-initiated, other clinical trials (phase I to phase III), federally funded trials, and projects at UTMDACC. Dr Ajani led two National Comprehensive Cancer Network (NCCN) Guidelines Panels (gastric cancer and oesophageal cancer) for over 25 years, was the chair of medical oncology for the Radiation Therapy Oncology Group for over 10 years and co-chair for GI cancers for 15 years.

    Dr Ajani has mentored numerous physicians, students, fellows and PhDs, and was the leader for developing gastric cancer staging for the 8th Edition of the American Joint Committee on Cancer (AJCC8). He was the co-chair (representing ASCO) for the 3-society guidelines for HER2 testing in gastroesophageal adenocarcinoma (senior author) and has contributed to The Cancer Genome Atlas for gastric and esophageal cancers (including specimens). He is also a member of two NCI Cancer Therapy Evaluation Program committees focused on esophageal and gastric cancers, and was on the program committee of the American Association for Cancer Research (AACR) from 2017 to 2018. Dr Ajani is currently a member of the Oncology Drug Advisory Committee of the FDA.

    Dr Ajani discloses

    Advisory board/panel fees from Acrotech Biopharma, Amgen, Arcus Biosciences, Astellas, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, DAVA Pharmaceuticals, Five Prime Therapeutics, Geneos Therapeutics, Gilead Sciences, GRAIL, Innovent Bio, Merck, Merck Serono, More, Novartis, OncLive, OncoTherics, Servier, Taiho Pharmaceutical, Vaccinogen, Zymeworks. Grants/research support from Astellas Pharma, Bristol Myers Squibb, Daiichi Sankyo, Delta-Fly Pharma, Gilead Sciences, LaNova Medicines, Leap Therapeutics, Merck, Prolinx, Roche, Taiho Pharmaceutical, Turning Point Therapeutics, Zymeworks.
    Dr Nataliya Uboha

    University of Wisconsin, Madison, WI, USA

    Dr Nataliya Uboha is an associate professor at the University of Wisconsin, Department of Medicine, Section of Hematology and Oncology, WI, USA, and a member of Carbone Cancer Center. read more

    Dr Uboha has significant clinical research experience, with a particular emphasis on phase I and biomarker-based clinical studies for patients with gastrointestinal (GI) malignancies. She is a faculty leader for the Cancer Therapy Discovery & Development (phase I) Program. She is a co-leader and founder of the Basket Disease Oriented Team at the University of Wisconsin, which has a specific focus on biomarker-based trials across disease types, and which has an ongoing collaboration with the Molecular Tumor Board, of which Dr Uboha is also an active member.

    Dr Uboha has a number of regional and national leadership roles. She serves on the board of Wisconsin Association of Hematology and Oncology and is a president-elect. She is a co-chair for GI Cancer Research Group in Big Ten Cancer Research Consortium. She is a chair of Upper GI Eastern Cooperative Oncology Group- American College of Radiology Imaging Network (ECOG-ACRIN) working groups, and is a national chair for a phase 3 ECOG clinical study (EA2183), which evaluates the role of consolidative radiation therapy in oligometastatic esophagogastric adenocarcinoma. She also serves on the National Cancer Institute upper GI task force as an ECOG-ACRIN representative.

    Dr Uboha discloses

    Advisory board/panel fees from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, BostonGene, Eisai, Elevation Oncology, GRAIL, Helsinn, Ipsen, Pfizer and QED Therapeutics. Consultancy fees from Astellas and Pfizer. Stock/Shareholder (self-managed) from Exact Sciences and Natera.
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    Personalized treatment of advanced HER2-negative gastric or gastroesophageal junction cancer: Current status and future perspectives

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    Dr Reetu Mukherji is an assistant professor of medicine within the Division of Hematology and Oncology at MedStar Georgetown Lombardi Comprehensive Cancer Center in Washington DC, USA. read more

    Dr Mukherji received her MD from the Lewis Katz School of Medicine at Temple University in Philadelphia, PA, completed her internal medicine residency at Thomas Jefferson University Hospital, and completed her haematology and oncology fellowship at MedStar Georgetown University Hospital. She is board certified in internal medicine, haematology and medical oncology.  

    Dr Mukherji is a medical oncologist specializing in the treatment of gastrointestinal (GI) cancers. Her research interests involve GI cancers, novel drug development, predictive and prognostic genomic biomarkers, circulating tumour DNA and circulating tumour cells. She has published in several peer-reviewed journals, including the Journal of Clinical Oncology, on the role of immunotherapies, applications of prognostic genomic biomarkers, and applications of liquid biopsies in the management of patients with GI malignancies. She is a member of the American Society of Clinical Oncology.

    Dr Mukherji discloses 

    Grants/research support from Genentech and Natera.

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    Dr Jaffer Ajani is a professor of medicine at a cancer centre in Houston, TX, USA. read more

    He received his doctor of medicine from Government Medical College, Nagpur, India. He is interested in upper gastrointestinal (GI) cancer research and focuses on combined modality trials for gastric and esophageal cancers. Dr Ajani has led numerous phase II and III randomized trials, has participated in cooperative groups and has participated actively in the International Society of Gastrointestinal Oncology (ISGIO). 

    Dr Ajani has significant expertise in coordinating multidisciplinary research in gastric and esophageal cancers, and has over 30 years of experience leading investigator-initiated, other clinical trials (phase I to phase III), federally funded trials, and projects at UTMDACC. Dr Ajani led two National Comprehensive Cancer Network (NCCN) Guidelines Panels (gastric cancer and oesophageal cancer) for over 25 years, was the chair of medical oncology for the Radiation Therapy Oncology Group for over 10 years and co-chair for GI cancers for 15 years. 

    Dr Ajani has mentored numerous physicians, students, fellows and PhDs, and was the leader for developing gastric cancer staging for the 8th Edition of the American Joint Committee on Cancer (AJCC8). He was the co-chair (representing ASCO) for the 3-society guidelines for HER2 testing in gastroesophageal adenocarcinoma (senior author) and has contributed to The Cancer Genome Atlas for gastric and esophageal cancers (including specimens). He is also a member of two NCI Cancer Therapy Evaluation Program committees focused on esophageal and gastric cancers, and was on the program committee of the American Association for Cancer Research (AACR) from 2017 to 2018. Dr Ajani is currently a member of the Oncology Drug Advisory Committee of the FDA.

    Dr Ajani discloses 

    Advisory board/panel fees from Acrotech Biopharma, Amgen, Arcus Biosciences, Astellas, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, DAVA Pharmaceuticals, Five Prime Therapeutics, Geneos Therapeutics, Gilead Sciences, GRAIL, Innovent Bio, Merck, Merck Serono, More, Novartis, OncLive, OncoTherics, Servier, Taiho Pharmaceutical, Vaccinogen, Zymeworks. Grants/research support from Astellas Pharma, Bristol Myers Squibb, Daiichi Sankyo, Delta-Fly Pharma, Gilead Sciences, LaNova Medicines, Leap Therapeutics, Merck, Prolinx, Roche, Taiho Pharmaceutical, Turning Point Therapeutics, Zymeworks.

    Take CE/CME Test

    Dr Nataliya Uboha is an associate professor at the University of Wisconsin, Department of Medicine, Section of Hematology and Oncology, WI, USA, and a member of Carbone Cancer Center. read more

    Dr Uboha has significant clinical research experience, with a particular emphasis on phase I and biomarker-based clinical studies for patients with gastrointestinal (GI) malignancies. She is a faculty leader for the Cancer Therapy Discovery & Development (phase I) Program. She is a co-leader and founder of the Basket Disease Oriented Team at the University of Wisconsin, which has a specific focus on biomarker-based trials across disease types, and which has an ongoing collaboration with the Molecular Tumor Board, of which Dr Uboha is also an active member.

    Dr Uboha has a number of regional and national leadership roles. She serves on the board of Wisconsin Association of Hematology and Oncology and is a president-elect. She is a co-chair for GI Cancer Research Group in Big Ten Cancer Research Consortium. She is a chair of Upper GI Eastern Cooperative Oncology Group- American College of Radiology Imaging Network (ECOG-ACRIN) working groups, and is a national chair for a phase 3 ECOG clinical study (EA2183), which evaluates the role of consolidative radiation therapy in oligometastatic esophagogastric adenocarcinoma. She also serves on the National Cancer Institute upper GI task force as an ECOG-ACRIN representative.

    Dr Uboha discloses

    Advisory board/panel fees from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, BostonGene, Eisai, Elevation Oncology, GRAIL, Helsinn, Ipsen, Pfizer and QED Therapeutics. Consultancy fees from Astellas and Pfizer. Stock/Shareholder (self-managed) from Exact Sciences and Natera.

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    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

    After watching this activity, participants should be better able to:

    • Describe the burden of disease and unmet treatment needs for patients with advanced HER2-negative GC/GEJC
    • Discuss the evidence for novel and emerging first-line targeted treatments for patients with HER2-negative advanced GC/GEJC
    • Explain the importance of biomarker testing for selection of targeted therapies in advanced GC/GEJC
    Overview

    In this activity, three US-based experts provide their insights into the current landscape in HER2-negative GC/GEJC, including clinical challenges and unmet needs, the latest evidence for new and emerging treatment strategies, and how biomarker testing is crucial for personalized therapy.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    Oncologists, gastric cancer specialists and oncology nurses specialists involved in the management of advanced HER2-negative gastric or gastroesophageal junction cancer.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Mukherji discloses 

    Grants/research support from Genentech and Natera.

    Dr Ajani discloses 

    Advisory board/panel fees from Acrotech Biopharma, Amgen, Arcus Biosciences, Astellas, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, DAVA Pharmaceuticals, Five Prime Therapeutics, Geneos Therapeutics, Gilead Sciences, GRAIL, Innovent Bio, Merck, Merck Serono, More, Novartis, OncLive, OncoTherics, Servier, Taiho Pharmaceutical, Vaccinogen, Zymeworks. Grants/research support from Astellas Pharma, Bristol Myers Squibb, Daiichi Sankyo, Delta-Fly Pharma, Gilead Sciences, LaNova Medicines, Leap Therapeutics, Merck, Prolinx, Roche, Taiho Pharmaceutical, Turning Point Therapeutics, Zymeworks.

    Dr Uboha discloses

    Advisory board/panel fees from Astellas Pharma, AstraZeneca, Bristol-Myers Squibb, BostonGene, Eisai, Elevation Oncology, GRAIL, Helsinn, Ipsen, Pfizer and QED Therapeutics. Consultancy fees from Astellas and Pfizer. Stock/Shareholder (self-managed) from Exact Sciences and Natera.

    Content reviewer

    Steven Ludlow, PharmD, MBA, BCOP, BCPS, has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Director

    Holly Gilbert-Jones has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    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 a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 20 April 2023. Date credits expire: 20 April 2024.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Personalized treatment of advanced HER2-negative gastric or gastroesophageal junction cancer: Current status and future perspectives

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    Topics covered in this activity

    Gastrointestinal Cancers
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    This Activity Is Funded By:

    An independent medical education grant from Astellas Pharma Inc.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 20 April 2023. Date credits expire: 20 April 2024.

    Claim Credit
    touchEXPERT OPINIONS
    Personalized treatment of advanced HER2-negative gastric or gastroesophageal junction cancer: Current status and future perspectives
    0.75 CE/CME credit
    Question 1/5
    In 2020, approximately how many gastric cancer deaths were there worldwide?

    In 2020, with an estimated 769,000 deaths, gastric cancer represented one of the most common causes of cancer death worldwide. Lung cancer was the leading cause of cancer death, followed by colorectal, liver, gastric and female breast cancers.

    Reference

    Sung H, et al. CA Cancer J Clin. 2021;71:209–49.

    Question 2/5
    Your patient has HER2 negative advanced gastric cancer with a PD-L1 CPS score of 8. According to the 2023 NCCN guidelines, which therapy could you consider initiating as first-line therapy?

    CAPOX, capecitabine-oxaliplatin; CPS, combined positive score; FOLFOX, folinic acid, fluorouracil and oxaliplatin; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; PD-L1, programmed death-ligand 1.

    The 2023 NCCN gastric cancer guidelines recommend that, for patients with HER2 overexpression negative advanced gastric cancer with a PD-L1 CPS score of ≥5, the immunotherapy that should be used is nivolumab combined with a fluoropyrimidine and oxaliplatin. The recommendation is category 1, which is defined by the NCCN as follows: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.

    Abbreviations

    CPS, combined positive score; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; PD-L1, programmed death-ligand 1.

    Reference

    NCCN. Gastric cancer. 2023. Available at: www.nccn.org/professionals/physician_gls/pdf/gastric.pdf (accessed 22 March 2023).

    Question 3/5
    You are talking to a patient with gastric adenocarcinoma about the recent GLOW clinical trial. How would you describe the targeted action of zolbetuximab?

    CLDN18.2, claudin 18.2; FGFR2b, fibroblast growth factor receptor 2b; HER2, human epidermal growth factor receptor 2; PD-L1, programmed death-ligand 1.

    CLDN18.2 has emerged as a promising targetable biomarker. Zolbetuximab is a chimeric IgG1 monoclonal antibody that specifically binds to CLDN18.2 and mediates cell death through antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity.

    Abbreviations

    CLDN18.2, claudin 18.2; IgG1, immunoglobulin G1. 

    Reference

    Shah MA et al. J Clin Oncol. 2020;38:TPS4648.

    Question 4/5
    Which splice variant of FGFR does the bemarituzumab antibody specifically bind to?

    FGFR, fibroblast growth factor receptor.

    Bemarituzumab is an anti-FGFR2b antibody specific to the FGFR2b splice variant, which leads to inhibition of FGF ligand binding, receptor internalization/degradation and antibody-dependent cell-mediated cytotoxicity.

    Abbreviations

    FGF, fibroblast growth factor; FGFR, fibroblast growth factor receptor.

    Reference

    Catenacci DV, et al. Future Oncol. 2019;15:2073–82.

    Question 5/5
    Your 49-year-old male patient has been newly diagnosed with advanced gastric adenocarcinoma. According to the NCCN 2023 guidelines, which of the following biomarkers would you test for via immunohistochemistry?

    CPS, combined positive score; dMMR, mismatch repair-deficient; HER2, human epidermal growth factor receptor 2; NCCN, National Comprehensive Cancer Network; NTRK, neurotrophic tyrosine receptor kinase; PD-L1, programmed death-ligand 1; TMB, tumour mutational burden.

    The 2023 NCCN guidelines for gastric cancer recommend that, for patients with inoperable locally advanced, recurrent, or metastatic adenocarcinoma of the stomach, assessment for tumour HER2 overexpression using immunohistochemistry is carried out. The guidelines also recommend that MMR testing by immunohistochemistry is carried out on all newly diagnosed gastric cancers, and loss of nuclear expression of one or more MMR proteins is evidence of dMMR. PD-L1 testing may be considered on locally advanced, recurrent, or metastatic gastric carcinomas in patients who are candidates for treatment with PD-1 inhibitors via immunohistochemistry. 

    Abbreviations

    HER2, human epidermal growth factor receptor 2; dMMR, MMR-deficient; MMR, mismatch repair; NCCN, National Comprehensive Cancer Network; PD-L1, programmed death-ligand 1.

    Reference

    NCCN. Gastric cancer. 2023. Available at: www.nccn.org/professionals/physician_gls/pdf/gastric.pdf (accessed 22 March 2023).

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    This Activity Is Funded By:

    An independent medical education grant from Astellas Pharma Inc.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 20 April 2023. Date credits expire: 20 April 2024.

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