Estimated Time to Complete Activity: 30 minutes

Statement of Need
Despite their reputation for being rare, recent results from an analysis of the Surveillance, Epidemiology, and End Results (SEER) database indicate that the incidence of neuroendocrine tumors (NETs) is rising. The increasing incidence may partly be due to improved awareness and diagnostic strategies in patients with NETs; however, the heterogeneity in morphology and clinical behavior of NETs still presents a significant challenge to accurate diagnosis and treatment. Tumors originate from neuroendocrine cells scattered throughout the body, are often indolent, and are resistant to therapy. Most well-differentiated NETs are classified as either carcinoid or pancreatic. The term carcinoid usually refers to tumors that arise outside of the pancreas, because pancreatic NETs tend to display a more aggressive clinical course, poorer prognosis, and different responses to chemotherapy. Well-differentiated NETs are associated with hormonal hypersecretion, which causes flushing, wheezing, diarrhea, right-sided valvular heart disease, gastrinoma, insulinoma, and glucagonoma. Treatments for patients with NETs are limited, but include surgery, hepatic embolization, somatostatin analogues, and interferon-alpha. More treatment options are needed to increase treatment efficacy, minimize toxicity, and prolong survival. Recent results from clinical trials indicate that agents targeting the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) may demonstrate clinical activity in patients with NETs. At the end of this activity, healthcare professionals will be able to discuss and evaluate results from clinical trials that are investigating the role of targeted agents inhibiting VEGF and mTOR in the treatment of patients with NETs.

Target Audience
This activity is designed for medical oncologists, radiation oncologists, surgical oncologists, nurses, pharmacists, physician assistants, and other healthcare professionals interested in the latest advances in the treatment and care of patients with advanced NETs.

Educational Objectives
Upon completion of this activity, participants will be able to

1. Evaluate results from clinical trials investigating the efficacy of angiogenesis inhibitors in the treatment of patients with NETs.
2. Discuss the role of mTOR inhibitors in the treatment of patients with NETs.

Method of Participation for Oncology Unplugged Podcast

This activity requires that your computer be configured to access the Internet. A high-speed Internet connection may be required to listen to large files. The podcast will be available on iTunes^® and www.thecbce.com. This podcast will also be a featured program on the CBCE CME app, which may be downloaded from the Apple^® App Store for use on the iPhone™ or iPod Touch^®.

Method of Participation for iPhone™ or iPod Touch^®
This activity can be accessed using an iPhone™ or iPod Touch^® and is a featured program on the CBCE CME app, which may be downloaded from the Apple^® App Store.

Accreditation
Physicians: The CBCE™ (The Center for Biomedical Continuing Education) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The CBCE designates this session for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in this activity.

Physician Assistants: AAPA accepts certificates of participation for educational activities certified for Category 1 credit from AOACCME, Prescribed credit from AAFP, and AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of .50 hour of Category 1 credit for completing this program.

Nurses: The CBCE™ (The Center for Biomedical Continuing Education) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

The CBCE designates this educational activity for .50 contact hour.

Accreditation by the American Nurses Credentialing Center’s Commission on Accreditation refers to recognition of educational activities and does not imply approval or endorsement of any product.

Pharmacists: The CBCE™ (The Center for Biomedical Continuing Education) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
CPE Credit: .50 contact hour or 0.050 CEU
Universal Program Number: 0195-0000-09-021-H01-P

Oncology Unplugged Credit Instructions
Successful completion of this activity includes the following:

• Score 70% or above on the posttest.
• Complete the Evaluation and Request for Credit Form.
• Fax the completed posttest and form to the CBCE, (214) 260-0509.

Participants will receive their certificate 4-6 weeks after the CBCE receives their posttest and form.

CBCE CME App Credit Instructions
Successful completion of this activity includes the following:

• Complete the online posttest and score 70% or above.
• Complete the online Evaluation and Request for Credit Form.

Participants will receive their certificates via e-mail 4-6 weeks after submission of the online Evaluation and Request for Credit Form.

Acknowledgement of Commercial Support
The CBCE gratefully acknowledges the educational grant provided by Novartis Pharmaceuticals Corporation.

Educational Inquiries
For further information, please contact the CBCE, 1707 Market Place Blvd., Suite 370, Irving, TX 75063; Phone: (214) 260-9024; Fax: (214) 260-0509; E-mail: info@thecbce.com.

Disclaimer
The content and views presented in this educational activity are those of the faculty and do not necessarily reflect the opinions or recommendations of the CBCE or Novartis Pharmaceuticals Corporation. This material has been prepared based on a review of multiple sources of information but is not comprehensive. Participants are advised to critically appraise the information presented, and they are encouraged to consult the available literature on any product or device mentioned in this program.

Disclosure of Unlabeled Uses
This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the US Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, please refer to the prescribing information for each product or consult the latest edition of the Physicians’ Desk Reference.

Disclosure of Financial Relationships With Any Commercial Interest
As a provider accredited by the ACCME, it is the policy of the CBCE to require that everyone who is in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest, and identify and resolve all conflicts of interest prior to the educational activity. The CBCE defines “relevant financial relationships” as any amount occurring within the past 12 months.

Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honorarium, ownership interest (eg, stocks, stock options, or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. The CBCE considers relationships of the person involved in the educational activity to include financial relationships of a spouse or partner.

Faculty who refuse to disclose relevant financial relationships will be disqualified from being a planning committee member, a teacher, or an author, and cannot have control of or responsibility for the development, management, presentation, or evaluation of the educational activity. For an individual with no relevant financial relationship, participants must be informed that no relevant financial relationship exists.

Disclosure of Potential Conflicts of Interest
The CBCE assesses conflicts of interest with its faculty, planners, and managers of CBCE activities. Identified conflicts of interest are thoroughly evaluated for fair balance, scientific objectivity relative to studies utilized in this activity, and patient-care recommendations. The CBCE is committed to providing participants with high-quality, unbiased, and state-of-the-art education.

The following faculty reported real or apparent conflicts of interest, and these conflicts have been resolved through a peer-review process:

Matthew H. Kulke, MD, MMSc
Consultant
Novartis Pharmaceuticals Corporation
Pfizer Inc.

James C. Yao, MD
Consultant
Endo Pharmaceuticals
Ipsen S.A.
Novartis Pharmaceuticals Corporation
Pfizer Inc.
Grant/Research Support
Novartis Pharmaceuticals Corporation
Honoraria
Ipsen S.A.
Novartis Pharmaceuticals Corporation

Institutional Disclosure
The CBCE receives educational grants from the pharmaceutical industry and other commercial sources. Companies providing grants to the CBCE include the commercial supporter of this activity as well as the manufacturers of certain drugs and/or devices discussed in this activity.

Staff Disclosure
The CBCE staff have declared they have no financial relationships that require disclosure.