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 ASCO-SEP®
MEDICAL ONCOLOGY SELF-EVALUATION PROGRAM

SIXTH EDITION

EDITOR
Martee L. Hensley, MD, MSc

ASSOCIATE EDITORS
Matthew I. Milowsky, MD
S. Vincent Rajkumar, MD
Scott M. Schuetze, MD, PhD

AUTHORS
Alex A. Adjei, MD, PhD
Frederick R. Appelbaum, MD
Shrujal Baxi, MD, MPH
Bruce E. Clurman, MD, PhD
Harvey Jay Cohen, MD
Howard A. Fine, MD
David R. Gandara, MD
Tara C. Gangadhar, MD
Jonathan E. Grim, MD, PhD
Tufia C. Haddad, MD
Martee L. Hensley, MD, MSc
Arif H. Kamal, MD, MBA, MHS
Ravindran Kanesvaran, BSc, MD, MRCP, FAMS
Brent R. Logan, PhD
Charles L. Loprinzi, MD
Rajiv S. Magge, MD
Matthew I. Milowsky, MD
Timothy J. Moynihan, MD
Rodrigo Ramella Munhoz, MD
Alfred I. Neugut, MD, PhD
David G. Pfister, MD
Michael A. Postow, MD
S. Vincent Rajkumar, MD
Jonathan W. Riess, MD, MS
Erin Salo-Mullen, MS, MPH, GCG
Lynn M. Schuchter, MD
Scott M. Schuetze, MD, PhD
Manish A. Shah, MD
Sonali M. Smith, MD
Zsofia K. Stadler, MD
Roland B. Walter, MD, PhD, MS
Copyright © 2018
American Society of Clinical Oncology, Inc.
2318 Mill Road, Suite 800
Alexandria, VA 22314
ISBN: 978-0-9983747-5-8

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by
the American Society of Clinical Oncology.

Permission requests should be directed to:

Rights and Permissions
American Society of Clinical Oncology
2318 Mill Road, Suite 800
Alexandria, VA 22314
Phone: 571-483-1722
Email: permissions@asco.org

Editorial correspondence should be directed to:

Education, Science, and Professional Development Department—ASCO-SEP®
American Society of Clinical Oncology
2318 Mill Road, Suite 800
Alexandria, VA 22314
Phone: 888-282-2552
Email: ascou@asco.org

The information presented is that of the contributing authors and does not necessarily represent the views of the American
Society of Clinical Oncology (ASCO). The information contained in ASCO-SEP® is provided solely for educational
purposes. The information and opinions herein do not constitute medical or legal advice. It is the responsibility of oncologists
and other health care professionals to determine, based on their individual judgment and experience, the appropriate course
of treatment for each patient. Physicians should not substitute this curriculum for the advice of legal counsel. ASCO
assumes no responsibility for errors or omissions in this publication.

Specific therapies discussed may not be approved and/or specified for use as indicated. Before prescribing any medication,
it is the responsibility of individual physicians to review the complete prescribing information, including indications,
contraindications, warnings, precautions, and adverse effects.

Printed in the United States of America.

Cover photograph, credit to STEVE GSCHMEISSNER/SCIENCE PHOTO LIBRARY, used with permission, is of cancer cells
and monocyte. Colored scanning electron micrograph (SEM) of the interaction between a monocyte and prostate cancer
cells. Monocytes activated by cytokines (cell signaling proteins) or other agents are cytotoxic for cancer cells. Magnification:
x 2500 when printed at 10 centimeters wide.
 LETTER FROM THE EDITOR

Dear Colleague:

On behalf of ASCO, I am pleased to present the 6th edition of ASCO-SEP®: Medical

Oncology Self-Evaluation Program. This self-evaluation resource was designed to assist
you in staying current in medical oncology, to provide test questions for assessing your
knowledge, and to assist you in your care of patients with cancer. In addition, through your
use of ASCO-SEP® you may earn credit for the maintenance of certification (MOC)
process. The response to the opportunity to receive MOC points for reading ASCO-SEP®
and completing the chapter-related multiple-choice questions has been tremendous. We will
continue to provide the opportunity to receive MOC points for your work with ASCO-SEP®
6th Edition.

ASCO-SEP® is a comprehensive learning tool that includes 22 chapters focused on specific

disease sites and oncology topics, as well as more than 180 multiple-choice questions that
can be used for self-study. The “Key Points” in each chapter section facilitate review of
important facts and concepts. ASCO-SEP® 6th Edition continues to feature vital updates at
the beginning of each chapter, highlighting new data that have significantly informed practice
and/or our understanding of cancer.

For this 6th edition, all of the self-assessment questions are new, providing learners with
unique opportunities for review. Also available is the ASCO-SEP® 6th Edition Mock
Examination, which can be accessed at ASCO University (university.asco.org/SEP). This
convenient online study tool provides yet another resource for self-evaluation. All questions
in the Mock Examination are new and do not include any test items from the book.

This ASCO-SEP® 6th Edition would not have been possible without the efforts of three
outstanding Associate Editors who dedicated substantial time and commitment to ensure
the high quality of the content: Matthew I. Milowsky, MD, Scott M. Schuetze, MD, PhD, and
S. Vincent Rajkumar, MD. The success of this publication has relied on the time and talents
of many contributors, including chapter authors and peer reviewers who graciously shared
their time and expertise. I am also grateful for the tireless and expert support of the ASCO
staff.

Thank you for participating in this worthwhile continuing medical education program. If you
have comments or suggestions regarding ASCO-SEP®, please email ascou@asco.org.

Sincerely,

Martee L. Hensley, MD, MSc

Editor, ASCO-SEP® 6th Edition
 EDITOR BIOGRAPHIES

Left to right: S. Vincent Rajkumar, MD, Matthew I. Milowsky, MD, Martee L. Hensley, MD, MSc, and Scott M. Schuetze, MD,
PhD

Martee L. Hensley, MD, MSc, is Professor of Medicine, Weill Cornell Medical College and
Attending Physician, Gynecologic Medical Oncology service, Memorial Sloan Kettering
Cancer Center. She serves as Co-Chair of the Uterine Task Force of the National Cancer
Institute’s Gynecologic Cancer Steering Committee, Co-Chair of the NCI-EORTC-Cancer
Research UK International Rare Cancer Initiative for Gynecologic Sarcomas, and as
member of the NRG Developmental Therapeutics and Uterine Corpus Committees. She is
Chair, Hospital Quality Assurance Committee, at Memorial Sloan Kettering.

Matthew I. Milowsky, MD, is an Associate Professor of Medicine and Urology, Section

Chief of the Genitourinary Oncology Service, and Co-Director of the Urologic Oncology
Program at the University of North Carolina at Chapel Hill Lineberger Comprehensive
Cancer Center.

S. Vincent Rajkumar, MD, is an Edward W. and Betty Knight Scripps Professor of

Medicine and Consultant in the Division of Hematology at the Mayo Clinic, Rochester,
Minnesota. He serves as Co-Chair of the International Myeloma Working Group, and Chair
of the NCI ECOG-ACRIN myeloma steering committee.

Scott M. Schuetze, MD, PhD, is Clinical Professor of Medicine in the Division of

Hematology/Oncology, University of Michigan Comprehensive Cancer Center. He is the
Director of the Connective Tissue Oncology Program in the University of Michigan
Comprehensive Cancer Center and Medical Co-Director of the Oncology Clinical Trials
Support Unit in Michigan Medicine.
 CONTRIBUTORS

EDITOR
Martee L. Hensley, MD, MSc
Memorial Sloan Kettering Cancer Center
New York, NY

ASSOCIATE EDITORS
Matthew I. Milowsky, MD
University of North Carolina
Lineberger Comprehensive Cancer Center
Chapel Hill, NC

S. Vincent Rajkumar, MD
Mayo Clinic
Rochester, MN

Scott M. Schuetze, MD, PhD

University of Michigan
Ann Arbor, MI

AUTHORS
Alex A. Adjei, MD, PhD
Mayo Clinic
Rochester, MN

Frederick R. Appelbaum, MD
Fred Hutchinson Cancer Research Center
Seattle, WA

Shrujal Baxi, MD, MPH

Memorial Sloan Kettering Cancer Center
New York, NY

Bruce E. Clurman, MD, PhD

Fred Hutchinson Cancer Research Center
Seattle, WA

Harvey Jay Cohen, MD

Duke University School of Medicine
Durham, NC

Howard A. Fine, MD
Weill Cornell Medicine
New York, NY
David R. Gandara, MD
UC Davis Comprehensive Cancer Center
Sacramento, CA

Tara C. Gangadhar, MD
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA

Jonathan E. Grim, MD, PhD

Fred Hutchinson Cancer Research Center
Seattle, WA

Tufia C. Haddad, MD
Mayo Clinic
Rochester, MN

Martee L. Hensley, MD, MSc

Memorial Sloan Kettering Cancer Center
New York, NY

Arif H. Kamal, MD, MBA, MHS

Duke University School of Medicine
Durham, NC

Ravindran Kanesvaran, BSc, MD, MRCP, FAMS

National Cancer Centre Singapore
Singapore

Brent R. Logan, PhD

Medical College of Wisconsin
Milwaukee, WI

Charles L. Loprinzi, MD
Mayo Clinic
Rochester, MN

Rajiv S. Magge, MD
Weill Cornell Medicine
New York, NY

Matthew I. Milowsky, MD
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, NC

Timothy J. Moynihan, MD
Mayo Clinic
Rochester, MN

Rodrigo Ramella Munhoz, MD

Hospital Sírio-Libanês
São Paulo, Brazil

Alfred I. Neugut, MD, PhD

Herbert Irving Comprehensive Cancer Center
New York, NY

David G. Pfister, MD
Memorial Sloan Kettering Cancer Center
New York, NY

Michael A. Postow, MD
Memorial Sloan Kettering Cancer Center
New York, NY

S. Vincent Rajkumar, MD
Mayo Clinic
Rochester, MN

Jonathan W. Riess, MD, MS

UC Davis Comprehensive Cancer Center
Sacramento, CA

Erin Salo-Mullen, MS, MPH, GCG

Memorial Sloan Kettering Cancer Center
New York, NY

Lynn M. Schuchter, MD
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA

Scott M. Schuetze, MD, PhD

University of Michigan
Ann Arbor, MI

Manish A. Shah, MD
Weill Cornell Medicine
New York, NY

Sonali M. Smith, MD
The University of Chicago Medical Center
Chicago, IL

Zsofia K. Stadler, MD
Memorial Sloan Kettering Cancer Center
New York, NY

Roland B. Walter, MD, PhD, MS

Fred Hutchinson Cancer Research Center
Seattle, WA

PEER REVIEWERS
David E. Avigan, MD
Beth Israel Deaconess Medical Center
Boston, MA

P. Leif Bergsagel, MD
Mayo Clinic
Phoenix, AZ

Jonathan Bleeker, MD
Sanford Health
Sioux Falls, SD

Dean E. Brenner, MD
University of Michigan
Ann Arbor, MI

Katherine L. Byar, MSN, APRN, BC, BMTCN

University of Nebraska
Omaha, NE

Joseph M. Connors, MD, FRCPC

BC Cancer Agency
Vancouver, British Columbia

Kelly J. Cooke, DO
ProHealth Care Palliative Services at ProHealth Waukesha Memorial Hospital
Waukesha, WI

Charles Lance Cowey, MD

Texas Oncology-Baylor Charles A. Sammons Cancer Center
Dallas, TX

Jennie R. Crews, MD, MMM, FACP

Seattle Cancer Care Alliance Network
Seattle, WA

Charmaine J. Cummings, PhD, RN

Society of Surgical Oncology
Rosemont, IL

Corey S. Cutler, MD, MPH, FRCPC

Dana-Farber Cancer Institute
Boston, MA

Sandra P. D'Angelo, MD
Memorial Sloan Kettering Cancer Center
New York, NY

William L. Dahut, MD
National Cancer Institute
Bethesda, MD

Don S. Dizon, MD, FACP

Lifespan Cancer Institute/Rhode Island Hospital
Providence, RI

Linda R. Duska, MD
University of Virginia
Charlottesville, VA

Mario A. Eisenberger, MD
Johns Hopkins Sidney Kimmel Cancer Center
Washington, DC

Alex Ganetsky, PharmD, BCOP

University of Pennsylvania Abramson Cancer Center
Philadelphia, PA

Marc B. Garnick, MD
Beth Israel Deaconess Medical Center
Boston, MA

Julie R. Gralow, MD
Seattle Cancer Care Alliance Network
Seattle, WA

Robert I. Haddad, MD
Dana-Farber Cancer Institute
Boston, MA

Daniel G. Haller, MD
Abramson Cancer Center at the Perelman School of Medicine at the University of Pennsylvania
Philadelphia, PA

Lee P. Hartner, MD
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA

Melissa L. Johnson, MD
Sarah Cannon Research Institute at Tennessee Oncology
Nashville, TN

Heidi D. Klepin, MD, MS

Wake Forest Baptist Health
Lexington, NC

Jill Lacy, MD
Yale Cancer Center
New Haven, CT

Thomas W. LeBlanc, MD
Duke University School of Medicine
Durham, NC

Benjamin P. Levy, MD
Johns Hopkins Sidney Kimmel Cancer Center
Washington, DC

Mark R. Litzow, MD
Mayo Clinic
Rochester, MN
Michael L. Maitland, MD, PhD
Inova Schar Cancer Institute
Falls Church, VA

Kim Margolin, MD
City of Hope
Duarte, CA

Vicki A. Morrison, MD
University of Minnesota, VA Medical Center
Minneapolis, MN

Stergios J. Moschos, MD
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, NC

Olufunmilayo I. Olopade, MD, FACP

The University of Chicago Medical Center
Chicago, IL

Antonio Omuro, MD
Memorial Sloan Kettering Cancer Center
New York, NY

Timothy S. Pardee, MD, PhD

Wake Forest Baptist Health
Lexington, NC

Blase N. Polite, MD, MPP

The University of Chicago Medical Center
Chicago, IL

Eric Roeland, MD
University of California San Diego
San Diego, CA

Joseph T. Ruggiero, MD
Weill Cornell Medicine
New York, NY

Richard Schwab, MD
University of California San Diego
San Diego, CA

Karen P. Seiter, MD
New York Medical College
Valhalla, NY

Kathy Selvaggi, MD, MS

Butler Health System
Butler, PA

Eva Szabo, MD
National Cancer Institute
Bethesda, MD

Carrie A. Thompson, MD
Mayo Clinic
Rochester, MN

Tiffany A. Traina, MD
Memorial Sloan Kettering Cancer Center
New York, NY

Ravi Vij, MD, MBA

Siteman Cancer Center
St. Louis, MO

Peter H. Wiernik, MD
Cancer Research Foundation
Chappaqua, NY

Marie E. Wood, MD
University of Vermont
Burlington, VT

Francis P. Worden, MD
University of Michigan
Ann Arbor, MI

ASCO STAFF
Publisher
Lisa J. Johnson, MHS, MT(ASCP)SC

Content Development Manager

Katherine B. Philips, PhD

Associate Content Development Manager

Stephanie Wamsley

Production Manager
Donna Dottellis
 DISCLOSURE INDEX

In compliance with standards established by the Accreditation Council for Continuing

Medical Education (ACCME), it is ASCO’s policy to ensure balance, independence,
objectivity, and scientific rigor in all of its educational activities through the disclosure of
financial relationships, among other measures. All ASCO-SEP® 6th Edition editors, authors,
and peer reviewers are required to disclose all relationships with commercial interests. The
financial interests or relationships requiring disclosure are outlined in ASCO’s Policy for
Relationships with Companies (asco.org/rwc).
The intent of this policy is to identify relationships openly, so readers can form their own
judgments about the publication in light of these relationships. It remains for readers to
determine whether the contributor’s outside interests reflect a possible bias in the
publication or the conclusions presented. The categories of relationships that contributors
are required to disclose are detailed here as a guide to the disclosure statements that
appear in the following Disclosure Index:

ITEMS REQUIRING DISCLOSURE

■ Employment
■ Leadership
■ Stock and Other Ownership Interests
■ Honoraria
■ Consulting or Advisory Role
■ Speakers’ Bureau
■ Research Funding
■ Patents, Royalties, Other Intellectual Property
■ Expert Testimony
■ Travel, Accommodations, Expenses
■ Other Relationship

EDITORIAL BOARD DISCLOSURES

Financial relationships reported by members of the ASCO-SEP® Editorial Board are
provided below. During all phases of planning, areas of conflict were managed through a
peer-review process and/or through individual recusal when appropriate. All relationships
are considered self-held and compensated unless otherwise noted. (I = immediate family
member; Inst = My Institution)
MARTEE L. HENSLEY, MD, MSc
• Employment: Sanofi (I)
• Stock and Other Ownership Interests: Sanofi (I)
• Consulting or Advisory Role: Onclive, Janssen, Lilly, Tesaro, EMD Serono
• Research Funding: Bristol-Myers Squibb (Inst), Johnson & Johnson (Inst)
• Patents, Royalties, Other Intellectual Property: Author, UpToDate

MATTHEW I. MILOWSKY, MD
• Research Funding: Inovio Pharmaceuticals (Inst), Innocrin Pharma (Inst), Incyte (Inst),
MedImmune (Inst), X4 Pharma (Inst), Bristol-Myers Squibb (Inst), Roche/Genentech
(Inst), BioClin Therapeutics (Inst), Merck (Inst), Cerulean Pharma (Inst), Pfizer (Inst),
Mirati Therapeutics (Inst), Acerta Pharma (Inst), Seattle Genetics (Inst)
• Travel, Accommodations, Expenses: Roche/Genentech

S. VINCENT RAJKUMAR, MD
• No Relationships to Disclose

SCOTT M. SCHUETZE, MD, PhD

• Consulting or Advisory Role: Daiichi Sankyo, Janssen, EMD Serono
• Research Funding: Adaptimmune (Inst), Karyopharm Therapeutics (Inst), Lilly (Inst),
Plexxikon (Inst), CytRx Corporation (Inst), BioMed Valley Discoveries (Inst), Amgen
(Inst), Janssen (Inst), AB Science (Inst)

AUTHOR DISCLOSURES

The ASCO-SEP® Editorial Board has reviewed all author disclosure reports, identified
potential conflicts of interest, and implemented strategies to manage those areas of
conflict, where they exist. All relationships are considered self-held and compensated
unless otherwise noted. (I = immediate family member; Inst = My Institution)

ALEX A. ADJEI, MD, PhD

• No Relationships to Disclose

FREDERICK R. APPELBAUM, MD
• Stock and Other Ownership Interests: Adaptive Biotechnologies, Igenica
• Honoraria: Amgen, Celator, National Marrow Donor Program, Neumedicines
• Consulting or Advisory Role: National Marrow Donor Program, Igenica

SHRUJAL BAXI, MD, MPH

• Consulting or Advisory Role: Bristol-Myers Squibb, AstraZeneca
• Travel, Accommodations, Expenses: AstraZeneca
BRUCE E. CLURMAN, MD, PhD
• No Relationships to Disclose

HARVEY JAY COHEN, MD

• No Relationships to Disclose

HOWARD A. FINE, MD
• No Relationships to Disclose

DAVID R. GANDARA, MD
• Consulting or Advisory Role: Synta, Novartis, Celgene, Boehringer Ingelheim,
AstraZeneca, Genentech, Merck, Pfizer, Sanofi, Response Genetics, Lilly, ARIAD,
Clovis Oncology, Guardant Health, Mirati Therapeutics
• Research Funding: Bristol-Myers Squibb (Inst), Genentech (Inst), Lilly (Inst), Merck
(Inst), Novartis (Inst), AstraZeneca/MedImmune (Inst), Clovis Oncology (Inst), Johnson
& Johnson (Inst)

TARA C. GANGADHAR, MD
• Honoraria: Medscape
• Research Funding: Merck (Inst), Incyte (Inst), Bristol-Myers Squibb (Inst)

JONATHAN E. GRIM, MD, PhD

• Stock and Other Ownership: Medtronic (I), Pfizer (I), Vanguard Health Care Mutual
Fund

TUFIA C. HADDAD, MD
• No Relationships to Disclose

MARTEE L. HENSLEY, MD, MSc

• Employment: Sanofi (I)
• Consulting or Advisory Role: EMD Serono, Insys Therapeutics, Janssen
• Research Funding: Johnson & Johnson (Inst)
• Patents, Royalties, Other Intellectual Property: Author, UpToDate

ARIF H. KAMAL, MD, MBA, MHS

• Consulting or Advisory Role: Insys Therapeutics

RAVINDRAN KANESVARAN, BSc, MD, MRCP, FAMS

• Honoraria: Astellas Pharma, Novartis, Janssen
• Consulting or Advisory Role: Pfizer, Astellas Pharma, Novartis, Mundipharma
• Research Funding: Sanofi (Inst), Janssen (Inst)
• Travel, Accommodations, Expenses: Astellas Pharma
BRENT R. LOGAN, PhD
• Consulting or Advisory Role: Telesta Therapeutics, Celgene, Rockwell Medical

CHARLES L. LOPRINZI, MD
• Consulting or Advisory Role: Cubist, Mitsubishi Tanabe Pharma, PledPharma, Lpath,
Coronado Biosciences, Insys Therapeutics (Inst), QUE Oncology (Inst), Metys (Inst),
Janssen (Inst)
• Research Funding: Pfizer (Inst), Janssen (Inst)
• Travel, Accommodations, Expenses: Cubist

RAJIV S. MAGGE, MD
• No Relationships to Disclose

MATTHEW I. MILOWSKY, MD
• Research Funding: BIND Therapeutics (Inst), Dendreon (Inst), Exelixis (Inst), Johnson &
Johnson (Inst), Mirati Therapeutics (Inst), Pfizer (Inst), Cerulean Pharma (Inst), Merck
(Inst), Seattle Genetics (Inst), Acerta Pharma (Inst), BioClin Therapeutics (Inst),
Roche/Genentech (Inst)

TIMOTHY J. MOYNIHAN, MD
• No Relationships to Disclose

RODRIGO RAMELLA MUNHOZ, MD

• Consulting or Advisory Role: Roche, MSD
• Speakers’ Bureau: Bristol-Myers Squibb, Roche, MSD, AstraZeneca
• Research Funding: Lilly, Roche
• Travel, Accommodations, Expenses: Bristol-Myers Squibb, MSD, Roche, AstraZeneca

ALFRED I. NEUGUT, MD, PhD

• Stock and Other Ownership Interests: Stemline Therapeutics
• Consulting or Advisory Role: Pfizer, Teva, Otsuka, United Biosource Corporation, EHE
International

DAVID G. PFISTER, MD
• Consulting or Advisory Role: Boehringer Ingelheim
• Research Funding: Boehringer Ingelheim, AstraZeneca, Exelixis, Novartis,
MedImmune, Merck

MICHAEL A. POSTOW, MD
• Honoraria: Bristol-Myers Squibb, Merck
• Consulting or Advisory Role: Amgen, Bristol-Myers Squibb
• Research Funding: Bristol-Myers Squibb (Inst)
• Travel, Accommodations, Expenses: Bristol-Myers Squibb

S. VINCENT RAJKUMAR, MD
• No Relationships to Disclose

JONATHAN W. RIESS, MD, MS

• Honoraria: Roche/Genentech
• Consulting or Advisory Role: Celgene, ARIAD, Clovis Oncology, Medtronic
• Research Funding: Onconova Therapeutics, Millennium (Inst), Novartis (Inst), Merck
(Inst)
• Travel, Accommodations, Expenses: Roche/Genentech, Celgene

ERIN SALO-MULLEN, MS, MPH, GCG

• No Relationships to Disclose

LYNN M. SCHUCHTER, MD
• Research Funding: GlaxoSmithKline (Inst), Merck (Inst), Bristol-Myers Squibb (Inst)

SCOTT M. SCHUETZE, MD, PhD

• Honoraria: EMD Serono, Janssen
• Consulting or Advisory Role: EMD Serono, Janssen
• Research Funding: AB Science (Inst), Janssen (Inst), Threshold Pharmaceuticals (Inst),
Amgen (Inst), ZIOPHARM Oncology (Inst), BioMed Valley Discoveries (Inst), CytRx
Corporation (Inst), Plexxikon (Inst), Lilly (Inst)

MANISH A. SHAH, MD
• Consulting or Advisory Role: Lilly
• Research Funding: Lilly/ImClone (Inst), Gilead Sciences (Inst), Merck (Inst)

SONALI M. SMITH, MD
• Honoraria: Celgene, Janssen
• Consulting or Advisory Role: Genentech/Roche, Seattle Genetics, TG Therapeutics,
Gilead Sciences, Seattle Genetics, Immunogenix, Pharmacyclics, NanoString
Technologies, Genmab

ZSOFIA K. STADLER, MD
• Consulting or Advisory Role: Allergan (I), Genentech/Roche (I), Regeneron (I), Optos
(I), Adverum (I)

ROLAND B. WALTER, MD, PhD, MS

• Consulting or Advisory Role: Amphivena Therapeutics, Covagen AG, AstraZeneca,
Seattle Genetics, Pfizer, Celgene, Janssen, Agios, BiolineRx, Emergent BioSolutions
• Research Funding: Seattle Genetics, Amgen, Celator, CSL Behring, Amphivena
Therapeutics, Abbvie, Arog, Pharmacyclics, Stemline Therapeutics, ADC Therapeutics,
Covagen AG
• Patents, Royalties, Other Intellectual Property: First Named Inventor: Combination of
epigenetic factors and bispecific compounds targeting CD33 and CD3 in the treatment of
myeloid leukemia

REVIEWER DISCLOSURES
The ASCO-SEP® Editorial Board has reviewed all peer reviewer disclosure reports,
identified potential conflicts of interest, and implemented strategies to manage those areas
of conflict, where they exist. (I= immediate family member; Inst= My Institution)

DAVID E. AVIGAN, MD
• Employment: Parexel
• Consulting or Advisory Role: Celgene, Seattle Genetics
• Research Funding: Genus Oncology, Astex Pharmaceuticals, Pharmacyclics

P. LEIF BERGSAGEL, MD, FASCO

• Consulting or Advisory Role: Incyte, Janssen, Juno Therapeutics, Adaptive
Biotechnologies
• Research Funding: Novartis

JONATHAN BLEEKER, MD
• Consulting or Advisory Role: Bristol-Myers Squibb (Inst)
• Travel, Accommodations, Expenses: Merck

DEAN E. BRENNER, MD
• Honoraria: Clinical Genomics
• Consulting or Advisory Role: Clinical Genomics
• Research Funding: Eiken Chemical, Volition RX, Clinical Genomics
• Travel, Accommodations, Expenses: Clinical Genomics

KATHERINE L. BYAR, MSN, APRN, BC, BMTCN

• Consulting or Advisory Role: Seattle Genetics
• Speakers’ Bureau: Medical Learning Group, Clinical Care Options

JOSEPH CONNORS, MD, FRCPC

• Research Funding: Seattle Genetics, Roche, Millennium

KELLY J. COOKE, DO
• No Relationships to Disclose
CHARLES LANCE COWEY, MD
• Employment: Texas Oncology
• Leadership: US Oncology, Baylor University Medical Center
• Honoraria: Bristol-Myers Squibb
• Consulting or Advisory Role: Bristol-Myers Squibb
• Speakers’ Bureau: Novartis, Genentech/Roche
• Research Funding: Bristol-Myers Squibb, Genentech/Roche, Takeda, Merck, Array
BioPharma

JENNIE CREWS, MD
• No Relationships to Disclose

CHARMAINE J. CUMMINGS, PhD, RN

• No Relationships to Disclose

COREY S. CUTLER, MD, MPH, FRCPC

• Stock and Other Ownership Interests: Bluebird Bio
• Consulting or Advisory Role: Incyte, REGiMMUNE, Pfizer, Seattle Genetics, Sandoz,
Insys Therapeutics, Pharmacyclics, Kite Pharma, Jazz Pharmaceuticals, Bristol-Myers
Squibb

SANDRA P. D'ANGELO, MD
• Consulting or Advisory Role: Nektar, Amgen, EMD Serono

WILLIAM DAHUT, MD
• No Relationships to Disclose

DON S. DIZON, MD
• Consulting or Advisory Role: UpToDate, Pfizer
• Research Funding: Aeterna Zentaris (Inst)

LINDA R. DUSKA, MD
• Consulting or Advisory Role: Parexel, Advance Medical, ClearView Healthcare
Partners, British Journal of Obstetrics and Gynecology, UpToDate
• Research Funding: GlaxoSmithKline (Inst), Millennium (Inst), Bristol-Myers Squibb
(Inst), Aeterna Zentaris (Inst), Millennium (Inst), Novartis (Inst), Abbvie (Inst), Tesaro
(Inst), Cerulean Pharma (Inst), Aduro Biotech (Inst), Advaxis (Inst), Syndax (Inst)
• Other Relationship: Genentech

MARIO A. EISENBERGER, MD
• Honoraria: Sanofi
• Consulting or Advisory Role: Astellas Pharma, Ipsen, Bayer, Sanofi
• Research Funding: Sanofi, Tokai Pharmaceuticals, Genentech
• Travel, Accommodations, Expenses: Bayer, Astellas Pharma, Sanofi

ALEX GANETSKY, PHARMD, BCOP

• Consulting or Advisory Role: Genentech, Jazz Pharmaceuticals
• Speakers’ Bureau: Amgen

MARC B. GARNICK, MD
• Stock and Other Ownership Interests: Immunogen, Valeant Pharmaceuticals
• Consulting or Advisory Role: Bayer Health, Clovis Oncology, Ferring, Tolmar, Array
BioPharma
• Expert Testimony: Rubin Anders
• Travel, Accommodations, Expenses: Ferring, Tolmar, Clovis Oncology

JULIE R. GRALOW, MD
• Consulting or Advisory Role: Novartis, Genentech, Bayer, Pfizer, Merck
• Research Funding: Roche/Genentech (Inst), Novartis (Inst)
• Travel, Accommodations, Expenses: Pfizer, Roche/Genentech

ROBERT I. HADDAD, MD
• Consulting or Advisory Role: Celgene, Bayer, Merck, Eisai, Bristol-Myers Squibb
• Research Funding: Boehringer Ingelheim (Inst), Merck (Inst), Bristol-Myers Squibb
(Inst), Celgene (Inst), AstraZeneca (Inst)

DANIEL G. HALLER, MD
• Consulting or Advisory Role: Genentech, Lilly
• Speakers’ Bureau: Taiho Pharmaceutical, Amgen, Genentech/Roche
• Expert Testimony: Celgene

LEE P. HARTNER, MD
• No Relationships to Disclose

MELISSA L. JOHNSON, MD
• Consulting or Advisory Role: Astellas Pharma (I), Otsuka (I)

HEIDI D. KLEPIN, MD, MS

• Consulting or Advisory Role: Celgene, Genentech
• Patents, Royalties, Other Intellectual Property: UpToDate

JILL LACY, MD
• Consulting or Advisory Role: Sirtex Medical
THOMAS W. LEBLANC, MD
• Honoraria: Helsinn Therapeutics, Celgene
• Consulting or Advisory Role: Epi-Q, Boehringer Ingelheim, Flatiron Health, Pfizer
• Research Funding: Helsinn Therapeutics (Inst), Opus Science/Celgene (Inst), Seattle
Genetics (Inst)
• Travel, Accommodations, Expenses: Pfizer

BENJAMIN P. LEVY, MD
• Honoraria: Genentech
• Consulting or Advisory Role: Lilly, Boehringer Ingelheim, Genentech/Roche,
AstraZeneca, Celgene, Pfizer, Merck
• Speakers’ Bureau: Lilly, Genentech/Roche

MARK R. LITZOW, MD
• Honoraria: Amgen
• Consulting or Advisory Role: Amgen
• Research Funding: Amgen, Astellas Pharma, Actinium Pharmaceuticals
• Travel, Accommodations, Expenses: Amgen

MICHAEL L. MAITLAND, MD, PhD

• Consulting or Advisory Role: Gilead Sciences (I), Bayer (I), Merck Sharpe & Dohme (I)

KIM MARGOLIN, MD
• Honoraria: Bristol-Myers Squibb, Genentech/Roche
• Consulting or Advisory Role: Amgen, ImaginAb
• Research Funding: Altor Bioscience, Bristol-Myers Squibb

VICKI A. MORRISON, MD
• Consulting or Advisory Role: Celgene, Merck, GlaxoSmithKline, Takeda
• Speakers’ Bureau: Celgene, Genentech, Gilead Sciences, Pharmacyclics

STERGIOS J. MOSCHOS, MD
• Consulting or Advisory Role: Merck Sharp & Dohme, Amgen, Prometheus, Castle
Biosciences
• Research Funding: Merck Sharp & Dohme, Pharmacyclics, Amgen, Genentech/Roche
• Travel, Accommodations, Expenses: Bristol-Myers Squibb, Merck Sharp & Dohme,
Novartis

OLUFUNMILAYO I. OLOPADE, MD, FACP

• Leadership: CancerIQ
• Stock and Other Ownership Interests: CancerIQ
• Research Funding: Novartis (Inst)
• Other Relationship: Myriad Genetics, Roche/Genentech, Color Genomics, Tempus

ANTONIO OMURO, MD
• Consulting or Advisory Role: Stemline Therapeutics, Juno Therapeutics, Bristol-Myers
Squibb, Oxigene, Alexion Pharmaceuticals, AstraZeneca, Inovio Pharmaceuticals,
Merck

TIMOTHY S. PARDEE, MD, PhD

• Consulting or Advisory Role: Janssen
• Speakers’ Bureau: Celgene, Novartis
• Research Funding: Cornerstone Pharmaceuticals
• Travel, Accommodations, Expenses: Celgene

BLASE N. POLITE, MD, MPP

• Consulting or Advisory Role: AstraZeneca, Pfizer
• Speakers’ Bureau: Bayer/Onyx
• Research Funding: Merck
• Other Relationship: Gerson Lehrman Group

ERIC ROELAND, MD
• Consulting or Advisory Role: Eisai (Inst), Helsinn Healthcare (Inst), HERON
• Speakers’ Bureau: Teva, Eisai, Depomed
• Research Funding: XBiotech (Inst), AstraZeneca (Inst), Merck (Inst)
• Travel, Accommodations, Expenses: Eisai, Teva, Helsinn Healthcare

JOSEPH T. RUGGIERO, MD
• No Relationships to Disclose

RICHARD SCHWAB, MD
• Stock and Other Ownership Interests: Samumed (I)
• Patents, Royalties, Other Intellectual Property: The patent covers sialylated glycans and
antibodies that specifically bind to them for early detection and diagnosis of cancer
(Inst)

KAREN P. SEITER, MD
• Employment: Hudson Valley Cancer Center
• Honoraria: Novartis
• Consulting or Advisory Role: Novartis, Celgene, Incyte, Alexion Pharmaceuticals
• Speakers’ Bureau: Novartis, Celgene, Incyte, Alexion Pharmaceuticals
• Research Funding: Novartis (Inst), Celgene (Inst), Incyte (Inst), Jazz Pharmaceuticals
(Inst), Janssen (Inst), FORMA Therapeutics (Inst), Daiichi Sankyo (Inst), Astellas
Pharma (Inst), Seattle Genetics (Inst)
• Travel, Accommodations, Expenses: Celgene, Agios, Novartis

KATHY SELVAGGI, MD, MS

• No Relationships to Disclose

EVA SZABO, MD
• No Relationships to Disclose

CARRIE A. THOMPSON, MD
• Research Funding: Kite Pharma

TIFFANY A. TRAINA, MD
• Consulting or Advisory Role: Genentech/Roche, Eisai, Halozyme, Mundipharma,
Medivation, Pfizer, AstraZeneca, Bayer, Research to Practice, Immunomedics, Merck
• Research Funding: Medivation, Eisai, Pfizer, Novartis, Myriad Genetics, Innocrin
Pharma, AstraZeneca

RAVI VIJ, MD, MBA

• Consulting or Advisory Role: Millennium, Onyx, Bristol-Myers Squibb, Celgene,
Janssen, Sanofi, Merck, Karyopharm Therapeutics, Kite Pharma, Shire, Jazz
Pharmaceuticals, Alexion Pharmaceuticals
• Research Funding: Onyx, Millennium
• Travel, Accommodations, Expenses: Millennium, Onyx, Celgene, Bristol-Myers Squibb,
Sanofi, Janssen, Pfizer, Binding Site, DAVAOncology, Shire, Karyopharm Therapeutics

PETER H. WIERNIK, MD
• Honoraria: TRACON Pharma, Novartis
• Travel, Accommodations, Expenses: Novartis

MARIE E. WOOD, MD
• No Relationships to Disclose

FRANCIS P. WORDEN, MD
• Honoraria: Bayer
• Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Genzyme
 CONTINUING EDUCATION AND
MAINTENANCE OF CERTIFICATION

PROGRAM OVERVIEW
The ASCO Self-Evaluation Program® (ASCO-SEP®) is a comprehensive resource
designed to help physicians assess their level of knowledge in the various areas of
oncology and provide a current understanding of cancer, its treatment, and the supportive
care needed to optimize the quality of life for people with cancer. This program includes 22
chapters and a companion self-assessment tool with rationales covering the full range of
topics in oncology, including major cancer types, epidemiology and cancer prevention,
management strategies for elderly patients, clinical trial design and statistics, molecular
biology, and an overview of biologic therapy.

TARGET AUDIENCE
ASCO-SEP® is targeted to fellows, practicing oncologists, and advanced practitioners.
ASCO-SEP® is also appropriate for use as a self-assessment tool for individual
professional development, or as a teaching tool for training and continuing education
purposes.

NEEDS STATEMENT
Although cancer mortality rates decreased 26% in the United States between 1991 and
2015, cancer still remains the second leading cause of death and is expected to become
the leading cause in the next few years.1 Globally, cancer is seen as an increasing burden,
with 14.1 million cases diagnosed and 8.2 million cancer deaths around the world in 2012,
and an estimated 32.6 million people surviving five or more years post-diagnosis.2 To meet
this challenge, the options available in medical oncology to treat patients with cancer
continue to grow in both breadth and complexity. Since the launch of the Fifth Edition of
ASCO-SEP®, for example, there have been over seventy drug approvals and safety
notifications from the U.S. Food and Drug Administration.3
ASCO-SEP® reflects within its chapters the state of oncology today. It is not meant to be
used as a textbook and does not typically include future directions for research. Rather, this
publication serves as a comprehensive overview of the subspecialty of oncology for use in
review, self-assessment, and teaching activities; to validate current knowledge; and to
improve overall competency in oncology.

LEARNING OBJECTIVES
Upon completion of this educational activity, participants will be able to:
● Apply the basic principles of epidemiology, molecular biology, clinical pharmacology, and
clinical trial design to the practice of oncology;
● Incorporate appropriate imaging and diagnostic techniques to accurately identify and
stage neoplastic disease;
● Discuss current treatment options with patients diagnosed with cancer and recommend
approaches based on current evidence; and
● Assess and mitigate potential symptoms affecting quality of life and relating to treatment
toxicity, comorbidities, or late effects.

CME ACCREDITATION STATEMENT

In support of improving patient care, the American Society of Clinical Oncology is jointly
accredited by the Accreditation Council for Continuing Medical Education (ACCME), the
Accreditation Council for Pharmacy Education (ACPE), and the American Nurses
Credentialing Center (ANCC) to provide continuing education for the healthcare team.
The American Society of Clinical Oncology designates this enduring material for a
maximum of 55.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit
commensurate with the extent of their participation in the activity.
The program content has been reviewed by the Oncology Nursing Certification
Corporation (ONCC) and is acceptable for recertification points.
ONCC review is only for designating content to be used for recertification points and is
not for CNE accreditation. CNE programs must be formally approved for contact hours by
an acceptable accreditor/approver of nursing CE to be used for recertification by ONCC. If
the CNE provider fails to obtain formal approval to award contact hours by an acceptable
accrediting/approval body, no information related to ONCC recertification may be used in
relation to the program.
Another random document with
no related content on Scribd:
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PART I.
BOOKS IN MANUSCRIPT.
 PART I.

BOOKS IN MANUSCRIPT.

INTRODUCTORY.

I n the year 410, Rome was captured and sacked by Alaric the
Visigoth. At this time, S. Jerome, in his cell at Bethlehem, was
labouring at his Commentaries on Ezekiel, while it was the downfall
of the imperial city which incited S. Augustine to begin the
composition of his greatest work, The City of God: “the greatest city
of the world has fallen in ruin, but the City of God abideth forever.”
The treatise required for its completion twenty-two books. “The
influence of France and of the printing-press,” remarks Hodgkin,
“have combined to make impossible the production of another De
Civitate Dei. The multiplicity of authors compels the controversialist
who would now obtain a hearing, to speak promptly and concisely.
The examples of Pascal and of Voltaire teach him that he must
speak with point and vivacity.”[1] S. Augustine was probably the most
voluminous writer of the earlier Christian centuries. He was the
author of no less than 232 books, in addition to many tractates or
homilies and innumerable epistles.[2] His literary work was continued
even during the siege of Hippo by the Vandals, and he died in Hippo
(in 431), in his seventy-sixth year, while the siege was still in
progress.
In regard to the lack of historical records of the time, I will again
quote Hodgkin, who, in his monumental work on Italy and Her
Invaders, has himself done so much to make good the deficiency: “It
is perhaps not surprising that in Italy itself there should have been
during the fifth century an utter absence of the instinct which leads
men to record for the benefit of posterity events which are going on
around them. When history was making itself at such breathless
speed and in such terrible fashion, the leisure, the inclination, the
presence of mind necessary for writing history might well be wanting.
He who would under happier auspices have filled up the interval
between the bath and the tennis court by reclining on the couch in
the winter portico of his villa and there languidly dictating to his slave
the true story of the abdication of Avitus, or the death of Anthemius,
was himself now a slave keeping sheep in the wilderness under a
Numidian sun or shrinking under the blows of one of the rough
soldiers of Gaiseric.”
Hodgkin finds it more difficult to understand “why the learned and
leisurely provincial of Greece, whose country for nearly a century
and a half (395-539) escaped the horrors of hostile invasion, and
who had to inspire them the grandest literary traditions in the world,
should have left unwritten the story of the downfall of Rome.”
“The fact seems to be,” he goes on to say, “that at this time all that
was left of literary instinct and historiographic power in the world had
concentrated itself on theological (we cannot call it religious)
controversy, and what tons of worthless material the ecclesiastical
historians and controversialists of the time have left us!... Blind, most
of them, to the meaning of the mighty drama which was being
enacted on the stage of the world ... they have left us scarcely a hint
as to the inner history of the vast revolution which settled the Teuton
in the lands of the Latin.... One man alone gives us that detailed
information concerning the thoughts, characters, persons of the
actors in the great drama which can make the dry bones of the
chronologer live. This is Caius Sollius Apollinaris Sidonius, man of
letters, imperial functionary, country gentleman, and bishop, who,
notwithstanding much manifest weakness of character and a sort of
epigrammatic dulness of style, is still the most interesting literary
figure of the fifth century.”[3]
Sidonius was born at Lyons, a.d. 430. His father, grandfather, and
great-grandfather had all served as Prætorian Prefects in Gaul, in
which province his own long life was passed. In 472, Sidonius
became Bishop of Arverni, and from that time, as he rather naïvely
tells us, he gave up (as unbecoming ecclesiastical responsibilities)
the writing of compositions “based on pagan models.” In 475, the
year before the last of the western emperors, Augustulus, was driven
from Rome by Odovacar,[4] the Herulian, the Visigoth king, Euric,
became master of Auvergne. Sidonius was at first banished, but in
479 was restored to his diocese, and continued his work there as
bishop and as writer until his death, ten years later. At the time of the
death of Sidonius, Cassiodorus, who was, during the succeeding
eighty years, to have part in so much of the eventful history of Italy,
was ten years old. There are some points of similarity in the careers
of the two men. Both were of noble family and both began their
active work as officials, one of the Empire, the other of the Gothic
kingdom of Italy, while both also became ecclesiastics. Each saw his
country taken possession of by a foreign invader, and for the
purpose of serving his countrymen, (with which purpose may very
possibly have been combined some motives of personal ambition,)
each was able and willing to make himself useful to the new ruler
and thus to retain official position and influence; and finally, both had
literary facility and ambition, and, holding in regard the works of the
great classic writers, endeavoured to model upon these works the
style of their own voluminous compositions. The political work of
Cassiodorus was of course, however, much the more noteworthy
and important, as Sidonius could hardly claim to be considered a
statesman.
In their work as authors, the compositions of Sidonius are, as I
judge from the description, to be ranked higher in literary quality than
those of the later writer, and to have been more successful also in
following the style of classic models. The style of Cassiodorus is
described as both verbose and grandiloquent. In his ecclesiastical,
or rather his monastic work, taken up after half a century of active
political life, it was the fortune of Cassiodorus, as will be described
later, to exercise an influence which continued for centuries, and
which was possibly more far-reaching than was exerted by the
career of any abbot or bishop in the later history of the Church.
 The careers of both Sidonius and Cassiodorus have a special
interest because the two men held rather an exceptional position
between the life of the old empire which they survived and that of the
new Europe of the Middle Ages, the beginning of which they lived to
see.
Of the writings of Sidonius, Hodgkin speaks as follows: “A careful
perusal of the three volumes of the Letters and Poems of Sidonius
(written between the years 455 and 490) reveals to us the fact that in
Gaul the air still teems with intellectual life, that authors were still
writing, amanuenses transcribing, friends complimenting or
criticising, and all the cares and pleasures of literature filling the
minds of large classes of men just as when no empires were sinking
and no strange nationalities suddenly arising around them.... A long
list of forgotten philosophers did exist in that age, and their works,
produced in lavish abundance, seem to have had no lack of eager
students.”
As an example of the literary interests of a country gentleman in
Gaul, Hodgkin quotes a letter of Sidonius, written about 469: “Here
too [i. e. in a country house in Gaul] were books in plenty; you might
fancy you were looking at the breast-high book-shelves (plantei) of
the grammarians, or the wedge-shaped cases (cunei) of the
Athenæum, or the well-filled cupboards (armaria) of the booksellers.
I observed, however, that if one found a manuscript beside the chair
of one of the ladies of the house, it was sure to be on a religious
subject, while those which lay by the seats of the fathers of the
family were full of the loftiest strains of Latin eloquence. In making
this distinction, I do not forget that there are some writings of equal
literary excellence in both branches, that Augustine may be paired
off against Varro, and Prudentius against Horace. Among these
books, the works of Origen, the Adamantine, were frequently
perused by readers holding our faith. I cannot understand why some
of our arch-divines should stigmatise him as a dangerous and
heterodox author.”[5]
In summing up the work of Sidonius, Hodgkin points out the
noteworthy opportunities for making a literary reputation which were
missed by him. “He might have been the Herodotus of mediæval