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Immunotherapy CE/CME ACCREDITED Watch Time: 46 mins

touchMDT Immune checkpoint inhibitors in solid tumours: Optimizing outcomes through multidisciplinary collaboration

A multidisciplinary team of specialists discuss the use of immune checkpoint inhibitor therapy in patients with solid tumours.

 Overview & Learning Objectives

Patient with a solid tumour who is a candidate for immunotherapy
Oncologist and oncology nurse
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Immune checkpoint inhibitors in solid tumours: Where are we now? Prof. Ken Kato, Ms Tara Hurley

Watch a medical oncologist and an oncology nurse discuss current and upcoming indications for immune checkpoint inhibitors in patients with solid tumours.

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Oncologist, oncology nurse and oncology pharmacist
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Strategies for identifying and monitoring immune-related adverse events Prof. Ken Kato, Ms Tara Hurley, Dr Alison Palumbo

Watch a medical oncologist, an oncology nurse and a clinical oncology pharmacist evaluate strategies for identifying and monitoring common immune-related adverse events associated with immunotherapy.

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Oncologist, oncology nurse and oncology pharmacist
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Approaches for managing immune-related adverse events Prof. Ken Kato, Ms Tara Hurley, Dr Alison Palumbo

Watch a medical oncologist, an oncology nurse and a clinical oncology pharmacist discuss current recommendations for managing systemic immune-related adverse events.

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Oncologist and pathologist
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The role of biomarkers in informing immune checkpoint inhibitor use across tumour types Prof. Ken Kato, Prof. Albrecht Stenzinger

Watch a medical oncologist and a pathologist review the role of biomarkers in guiding ICI therapy in patients with solid tumours.

Watch Video
Oncologist and oncology nurse

Watch a medical oncologist and an oncology nurse discuss current and upcoming indications for immune checkpoint inhibitors in patients with solid tumours.
Expert Spotlight
Prof. Ken Kato
National Cancer Center Hospital, Tokyo, Japan
Ms Tara Hurley
Royal Marsden NHS Foundation Trust, Sutton, UK

Prof. Ken Kato and Ms Tara Hurley discuss current and upcoming indications for immune checkpoint inhibitors in patients with solid tumours, including key disease-specific considerations when developing individual treatment strategies.

Listen on the Go

 Learn More Back to MDT Hub Time: 12:24
 
Oncologist, oncology nurse and oncology pharmacist

Watch a medical oncologist, an oncology nurse and a clinical oncology pharmacist evaluate strategies for identifying and monitoring common immune-related adverse events associated with immunotherapy.
Expert Spotlight
Prof. Ken Kato
National Cancer Center Hospital, Tokyo, Japan
Ms Tara Hurley
Royal Marsden NHS Foundation Trust, Sutton, UK
Dr Alison Palumbo
Oregon Health and Science University, Portland, OR, USA

Prof. Ken Kato, Ms Tara Hurley and Dr Alison Palumbo evaluate strategies for identifying and monitoring common immune-related adverse events associated with immunotherapy, and how the risks of developing immune-related adverse events can be predicted and mitigated.

Listen on the Go

 Learn More Back to MDT Hub Time: 11:13
 
Oncologist, oncology nurse and oncology pharmacist

Watch a medical oncologist, an oncology nurse and a clinical oncology pharmacist discuss current recommendations for managing systemic immune-related adverse events.
Expert Spotlight
Prof. Ken Kato
National Cancer Center Hospital, Tokyo, Japan
Ms Tara Hurley
Royal Marsden NHS Foundation Trust, Sutton, UK
Dr Alison Palumbo
Oregon Health and Science University, Portland, OR, USA

Prof. Ken Kato, Ms Tara Hurley and Dr Alison Palumbo discuss current recommendations for managing systemic immune-related adverse events, including considerations for referral to organ specialists.

Listen on the Go

 Learn More Back to MDT Hub Time: 10:38
 
Oncologist and pathologist

Watch a medical oncologist and a pathologist review the role of biomarkers in guiding ICI therapy in patients with solid tumours.
Expert Spotlight
Prof. Ken Kato
National Cancer Center Hospital, Tokyo, Japan
Prof. Albrecht Stenzinger
University Hospital Heidelberg, Heidelberg, Germany

Prof. Ken Kato and Prof. Albrecht Stenzinger review the role of biomarkers in guiding immune checkpoint inhibitor therapy in patients with solid tumours, including associated challenges and limitations, and discuss how effective biomarker testing can be used in clinical practice.

Listen on the Go

 Learn More Back to MDT Hub Time: 11:37
 
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Overview & Learning Objectives
Overview

In this activity, a medical oncologist, an oncology nurse, a clinical oncology pharmacist and a pathologist share their insights on the role and impact of immune checkpoint inhibitor therapy in treating patients with solid tumours, discuss approaches for identifying, monitoring and managing immune-related adverse events, and review the role of biomarkers in informing immunotherapy use across tumour types.

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

Target Audience

This activity has been designed to meet the educational needs of medical oncologists and oncology nurses involved in the management of patients with solid tumours.

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

Prof. Ken Kato discloses: Advisory board or panel fees from AstraZeneca, Bayer, Bristol Myers Squibb, Chugai, Janssen, Merck Bio, MSD and ONO. Consultancy fees from Daiichi-Sankyo, Seagen and Servier. Grants/research support from Bristol Myers Squibb, Merck Bio, ONO and Taiho. Speaker’s bureau fees from Bristol Myers Squibb, MSD and ONO.

Ms Tara Hurley has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Alison Palumbo discloses: Advisory board or panel fees from Pfizer, Pharmacy Times and Regeneron (relationships terminated). Consultancy fees from Market Access Transformation and Precision Value. Grants/research support from Hematology/Oncology Pharmacy Association (relationships terminated).

Prof. Albrecht Stenzinger discloses: Advisory board or panel fees from AGCT, AstraZeneca, Bayer, Bristol Myers Squibb, Eli Lilly, Illumina, Janssen, MSD, Novartis, Pfizer, Roche, Seattle Genetics, Takeda and Thermo Fisher. Grants/research support from Bayer, BMS, Chugai and Incyte.

Content reviewer

Danielle Walker, DNP, APRN, AGNP-C has no relevant financial relationships to disclose.

Touch Medical Director

Anne Nunn 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 1.0 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 1.0 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.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 1.0 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 1.0 ANCC pharmacotherapeutic contact hour.

Date of original release: 8 June 2023. Date credits expire: 8 June 2024.

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

Learning Objectives

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

  • Use the most appropriate ICI to treat solid tumours based on disease and patient characteristics
  • Summarize the challenges associated with the recognition and management of irAEs
  • Discuss the role of biomarkers to guide the use of ICI therapy in patients with solid tumours
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Faculty & Disclosures
Prof. Ken Kato

National Cancer Center Hospital, Tokyo, Japan

Prof. Ken Kato is a medical oncologist and chief of the Departments of Head and Neck and Esophageal Medical Oncology and Gastrointestinal Medical Oncology at the National Cancer Center Hospital, in Tokyo, Japan. He is also chief of the Biobank Translational Research Support Section, Clinical Research Coordinating Section and Clinical Research Support Office at the National Cancer Center Hospital. read more

Prof. Kato’s primary interest is chemotherapy and chemoradiotherapy for oesophageal, oesophagogastric and gastric cancer. He is a group coordinator of the Japan Esophageal Oncology Group of Japan Clinical Oncology Group, the most significant clinical trial group for cancer in Japan. The group has conducted clinical trials to develop new chemotherapy for metastatic disease and early oesophageal cancer in multimodality therapy. He is also a steering committee member for numerous international phase III trials assessing immune checkpoint inhibitors in oesophageal cancer.

Prof. Kato is a director of the Japan Esophageal Society and plays an active role in supporting the society within Asia and internationally.

Prof. Ken Kato discloses: Advisory board or panel fees from AstraZeneca, Bayer, Bristol Myers Squibb, Chugai, Janssen, Merck Bio, MSD and ONO. Consultancy fees from Daiichi-Sankyo, Seagen and Servier. Grants/research support from Bristol Myers Squibb, Merck Bio, ONO and Taiho. Speaker’s bureau fees from Bristol Myers Squibb, MSD and ONO.
Ms Tara Hurley

Royal Marsden NHS Foundation Trust, Sutton, UK

Ms Tara Hurley is matron in Cancer Services at the Royal Marsden NHS Foundation Trust in Sutton, UK. read more

Ms Hurley has been working as a registered nurse in oncology since 2009, in a world-leading oncology centre. She worked in a ward-based clinical capacity before moving into oncology clinical trials in 2010. Ms Hurley progressed to the role of lead clinical research nurse until 2022, when she was appointed as a matron. She currently leads two inpatient ward environments and one outpatient team.

Ms Hurley is an extremely passionate and dedicated oncology nurse aspiring to afford patients the optimum care and treatment as they navigate their oncology diagnosis.

Ms Tara Hurley has no interests/relationships or affiliations to disclose in relation to this activity.
Dr Alison Palumbo

Oregon Health and Science University, Portland, OR, USA

Dr Alison Palumbo is a clinical oncology pharmacist at Oregon Health and Science University in Portland, OR, USA, and an assistant professor of clinical practice at the Oregon State University College of Pharmacy, Portland. read more

Dr Palumbo completed her Doctor of Pharmacy and Master in Public Health degrees at the University of Kentucky, her PGY1 pharmacy practice residency at the University of Michigan Medicine and PGY2 oncology pharmacy residency at the University of Washington Medicine. Dr Palumbo’s primary interests include breast cancer, supportive care and global health. She is also the founder and president of the non-profit organization, Banyan Tree Clinics.

Dr Alison Palumbo discloses: Advisory board or panel fees from Pfizer, Pharmacy Times and Regeneron (relationships terminated). Consultancy fees from Market Access Transformation and Precision Value. Grants/research support from Hematology/Oncology Pharmacy Association (relationships terminated).
Prof. Albrecht Stenzinger

University Hospital Heidelberg, Heidelberg, Germany

Prof. Albrecht Stenzinger is professor of molecular tumour pathology and deputy director of the Institute of Pathology (IPH), as well as the head of the IPH Center for Molecular Pathology and section head for Molecular Diagnostics and Biomarker Development at the IPH, University Hospital Heidelberg, Germany. read more

Prof. Stenzinger completed his MD degree at the University of Giessen, Germany, his residency and fellowship training in pathology at the Charité University Hospital in Berlin and the University Hospital Heidelberg, Germany, and is a board-certified surgical pathologist, a molecular pathologist and senior consultant pathologist. Prof. Stenzinger received postdoctoral training at the University of Heidelberg, Germany, and Massachusetts General Hospital/Harvard Medical School, USA. He has broad expertise in molecular pathology and works primarily in translational research and genetics of solid tumours, including lung cancer.

Prof. Albrecht Stenzinger discloses: Advisory board or panel fees from AGCT, AstraZeneca, Bayer, Bristol Myers Squibb, Eli Lilly, Illumina, Janssen, MSD, Novartis, Pfizer, Roche, Seattle Genetics, Takeda and Thermo Fisher. Grants/research support from Bayer, BMS, Chugai and Incyte.
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This Activity Is Funded By:

An independent medical education grant from MSD.
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: 8 June 2023. Date credits expire: 8 June 2024.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/4
In a consultation prior to initiating nivolumab for the treatment of melanoma, you discuss with your patient the possibility of experiencing pseudoprogression. Which statement might you include in your advice?
 Correct

Pseudoprogression is an atypical treatment response, occurring in ≤20% of patients across solid tumour types, where the primary tumour increases in size, or new lesions appear, prior to tumour regression.1 Pseudoprogression is usually accompanied by an improvement in general condition, a feature that may help to distinguish it from true progression, which is typically associated with deterioration.1 Studies have found that patients treated with immunotherapy who experience pseudoprogression have a better prognosis than those with true progression or stable disease.2,3 However, pseudoprogression often leads to premature discontinuation of treatment through misdiagnosis of true progression; therefore, early and accurate identification is important.3,4

References

  1. Ma Y, et al. Am J Cancer Res. 2019;9:1546–53.
  2. Kurra V, et al. J Clin Oncol. 2016;34:6580.
  3. Senturk Oztas N, et al. IOTech. 2022;16(Suppl.)100216.
  4. Jia W, et al. Cancer Biol Med. 2019;16:655–70.
Question 2/4
You are counselling your patient on the need to attend regular follow-up examinations to monitor the efficacy and any side effects of their ICI treatment. Which of the following statements regarding irAEs might you include in your advice?

ICI, immune checkpoint inhibitor; irAE, immune-related adverse event.
 Correct

Several low-grade irAEs are asymptomatic and can only be identified through blood tests or imaging.1,2 For example, grade 3 hepatitis may only be identified by elevated transaminases in a blood liver function test, but permanent cessation of ICI treatment should be considered in these patients.1,2 Similarly, grade 1 pneumonitis is identified by clinical or diagnostic observations, but in these cases, ICI treatment should be continued with close monitoring or should be withheld.1 Active monitoring for signs and symptoms of irAEs and regular clinical and laboratory examinations at ICI initiation, throughout the treatment period and after discontinuation can help facilitate early diagnosis and effective management.3

Abbreviations

ICI, immune checkpoint inhibitor; irAE, immune-related adverse event.

References

  1. Schneider BJ, et al. J Clin Oncol. 2021;39:4073–126.
  2. Puzanov I, et al. J Immunother Cancer. 2017;5:95.
  3. Medina P, et al. J Pharm Pract. 2020;33:338–49.
Question 3/4
Your 65-year-old patient with metastatic squamous cell carcinoma of the head and neck returns to the clinic to receive his fifth cycle of nivolumab. Despite the patient feeling well, a routine pre-infusion blood test reveals grade 2 ALT increase and a grade 1 AST increase. What is your immediate course of action?

ALT, alanine transaminase; AST, aspartate aminotransferase; ICI, immune checkpoint inhibitor.
Correct

Guidelines from the Society for Immunotherapy of Cancer Toxicity Management Working Group and the American Society of Clinical Oncology state that, for asymptomatic, grade 2 liver toxicity (ALT or AST >3 to ≤5× ULN and/or total bilirubin >1.5 to ≤3× ULN), ICI treatment should be suspended and prednisone 0.5–1.0 mg/kg/day (or equivalent methylprednisolone dose) initiated, with a 4-week taper.1,2 ICI treatment may be resumed when corticosteroid dose is reduced to 10 mg/day and toxicity is grade ≤1.1,2 The US prescribing information and European summary of product characteristics for nivolumab also state that treatment should be withheld in cases of AST/ALT increases to >3 and ≤8× ULN and resumed in patients with improvement to grade ≤1 after corticosteroid taper.3,4

Abbreviations

ALT, alanine transaminase; AST, aspartate aminotransferase; ICI, immune checkpoint inhibitor; ULN, upper limit of normal.

References

  1. Puzanov I, et al. J Immunother Cancer. 2017;5:95.
  2. Schneider BJ, et al. J Clin Oncol. 2021;39:4073–126.
  3. FDA. Nivolumab PI. Available at: bit.ly/3HAqZOb (accessed 6 April 2023).
  4. EMA. Nivolumab SmPC. Available at: bit.ly/3HzbG8H (accessed 6 April 2023).
Question 4/4
Which of the following biomarker results most strongly predicts that a patient will respond favourably to treatment with an immune checkpoint inhibitor?

PD-L1, programmed death-ligand 1; TMB, tumour mutation burden.
 Correct

PD-L1 and TMB are predictive biomarkers approved for clinical use.1 PD-L1 expression thresholds of 1%, 5%, 10% and 50% are reported in the literature and, although inconsistent, a general trend of increased ICI efficacy with higher PD-L1 expression has been identified.1 A meta-analysis showed a significant positive correlation between TMB and objective response rate (p<0.001) across 27 tumour types/subtypes in patients treated with anti–PD-(L)1 therapy.2 A more recent meta-analysis in patients with resectable early-stage non-small cell lung cancer showed that high PD-L1 expression and high TMB are associated with a higher rate of major pathologic response and pathologic complete response to neoadjuvant PD-(L)1 blockade than low PD-L1 expression and low TMB.3

Abbreviations

ICI, immune checkpoint inhibitor; PD-1, programmed cell death protein 1; PD-L1, programmed death-ligand 1; TMB, tumour mutation burden.

References

  1. Li H, et al. Br J Cancer. 2022;126:1663–75.
  2. Yarchoan M, et al. N Engl J Med. 2017;377:2500–1.
  3. Deng H, et al. Crit Rev Oncol Hematol. 2022;170:103582.
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