Incorporating Immunotherapy Into Treatment for MSI-H/dMMR Colorectal Cancer: Latest Updates on Testing, Treatment, and irAE Management
Release Date: February 27, 2019
Last Reviewed: February 23, 2019
Expiration Date: February 27, 2020
Time to Complete Activity: 1.25 hours

*This activity expired for credit on February 27, 2020 and is no longer available for credit

Michael J. Overman, MD (Chair)
Department of Gastrointestinal Medical Oncology
Center Medical Director, Ambulatory Treatment Center
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX
Richard Kim, MD
Section Chief of GI Medical Oncology
Department of Gastrointestinal Oncology
Moffitt Cancer Center
Associate Professor
Division of Medical Oncology
University of South Florida College of Medicine
Tampa, FL
Johanna Bendell, MD
Chief Development Officer
Sarah Cannon Research Institute
Tennessee Oncology
Nashville, TN
This activity is provided by Paradigm Medical Communications, LLC.  

Target Audience
This activity has been designed to address the educational needs of oncologists who treat patients with colorectal cancer (CRC). The activity may also benefit other oncology healthcare professionals involved in the management of patients with CRC.
Statement of Need
Although immunotherapy has been available for other solid tumors since 2011, several immunotherapy regimens were recently approved for the treatment of relapsed/refractory CRC with high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR), ushering in a new treatment paradigm. Because these agents are new to CRC, many oncology clinicians are not yet familiar with the latest clinical trial data or how to use these agents in clinical practice. In addition, many oncology clinicians are not familiar with the concept of MSI-H or dMMR, and therefore fail to follow universal testing guidelines. As a result, many patients do not receive testing and therefore may not receive immunotherapy. Furthermore, immunotherapy is associated with immune-related adverse events (irAEs), which are distinct from toxicities frequently observed with chemotherapy or targeted therapy. Many oncology clinicians still have difficulty recognizing and appropriately managing irAEs. Therefore, this activity will feature an expert-led, case-based discussion of biomarker testing, the latest on the use of immunotherapy, and managing potential irAEs in patients with CRC.
Learning Objectives
Upon proper completion of this activity, participants should be better able to:
  • Use results of MSI/dMMR testing to determine appropriate management of advanced CRC.
  • Formulate treatment plans for advanced CRC using immune checkpoint inhibition, alone or in combination with other therapies, based on the latest clinical trial data.
  • Apply evidence-based strategies to monitor for, recognize, and effectively manage potential irAEs associated with immune checkpoint inhibition.

Table of Contents
  • Introduction to Microsatellite Instability (MSI) and Mismatch Repair (MMR) in CRC
    Michael J. Overman, MD
  • Case 1: Patient With Metastatic CRC Richard Kim, MD
  • Case 2: Patient With Relapsed/Refractory CRC With MSI-H/dMMR
    Michael J. Overman, MD
  • Case 3: Patient With CRC Receiving Immunotherapy Develops an irAE
    Johanna Bendell, MD
  • Faculty Roundtable Discussion and Conclusion Faculty Panel
Physician Accreditation Statement
Paradigm Medical Communications, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Physician Credit Designation Statement
Paradigm Medical Communications, LLC designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

PA Continuing Education
PAs may claim a maximum of 1.25 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.
Nurse Practitioner Continuing Education
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.
Disclosure of Commercial Support
This activity is supported by an educational grant from Bristol-Myers Squibb.
Instructions for Participation
To receive a CME certificate of participation, you should:
  • Follow instructions to register or log in with your professional information and complete the pre-activity assessment
  • View the online activity in its entirety.
  • Complete and submit the online posttest and evaluation.
A certificate of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.

For questions regarding CME credit, contact the Paradigm CME Department at (845) 398-5949.
There is no fee required for participation in this activity.
Hardware/Software Requirements
This certified CME activity is designed using HTML5 media controls. As you navigate the video using the supplied controls, the slides will sync to the speaker.
Supported Browsers:
For Desktops (Windows/Mac)
Internet Explorer 9 or higher, Firefox 28 or higher, Safari 5.1 or higher, Google Chrome 31 or higher, Opera 21 or higher
For Tablets (iPad/Android/Surface)
iOS Safari 4 or higher, Android 2.3 or higher, IE Mobile 10 or higher

Technical Support: If you have any technical problems or playback issues, email us at
In accordance with Accreditation Council for Continuing Medical Education requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below.
Michael J. Overman, MD
Grant/Research Support: AstraZeneca; Bristol-Myers Squibb Company; Merck & Co., Inc
Retained Consultant: AstraZeneca; Bristol-Myers Squibb Company; Roche
Richard Kim, MD
Grant/Research Support: Bayer HealthCare; Bristol-Myers Squibb Company; Eisai, Inc
Retained Consultant: Bayer HealthCare; Bristol-Myers Squibb Company; Eisai, Inc
Speakers Bureau: Eli Lilly and Company
Johanna Bendell, MD
No financial relationships to disclose.
Paradigm Medical Communications, LLC staff members have no financial relationships to disclose.

Peer reviewer, Marwan G. Fakih, MD, has the following relationships to disclose:
Retained Consultant: Array BioPharma, Seattle Genetics, Inc
Speakers Bureau: Amgen Inc
Resolution of Conflict of Interest
Paradigm Medical Communications, LLC has implemented a system to resolve conflicts of interest for each CME activity to help ensure content is objective, fair and balanced, independent, and aligned with the public interest. Conflicts, if any, are resolved through one or more processes. All CME content in this activity was independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance and the ACCME’s Standards for Commercial Support of Continuing Medical Education.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA.
This CME activity represents the views and opinions of the individual faculty, and does not constitute the opinion or endorsement of, or promotion by, Paradigm Medical Communications, LLC. Reasonable efforts have been taken to present educational subject matter in a balanced, unbiased fashion, and in compliance with regulatory requirements. However, each activity participant must always use his or her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

If included, signed statements of informed consent granting permission for publication have been obtained for all photographs and videos in which an individual can be identified.
As an ACCME-accredited provider, Paradigm Medical Communications, LLC activities must include a balanced view of therapeutic options. Use of generic names contributes to this impartiality. The use of trade names should not be viewed as an endorsement of specific products by Paradigm Medical Communications, LLC.
Terms of Use and Privacy Policy
The materials provided for this activity are for informational purposes only, and should not be used for diagnosis or treatment of a health problem without consulting a licensed medical professional. Any views or opinions presented are solely those of the faculty, and do not necessarily represent those of Paradigm Medical Communications, LLC. References to any entity, product, service, or source of information on this website should not be considered an endorsement, either direct or implied, by Paradigm Medical Communications, LLC. Paradigm Medical Communications, LLC accepts no liability for the content referenced in this activity.
Privacy policy
Paradigm Medical Communications, LLC is committed to protecting the privacy of those who participate in the activities located at (herein referred to as “website"). The information below describes the security of the website for safeguarding personal information and the rationale for collection and use of personal information.
Security/safeguarding personal information
This website has physical and procedural safeguards in place to prevent unauthorized access to personal information used to access this website.
Collection and use of your personal information
The submission of certain personally identifiable information is necessary to award and track the credits participants may earn after completing the program. Required items include first name, last name, degree, and email address. These items are necessary. Participants are also required to complete an evaluation of the CME activity. All evaluative information submitted is collected and retained, and used by Paradigm Medical Communications, LLC to continuously improve the learning experience.
Paradigm Medical Communications, LLC does not transfer, sell, or share personal information with outside parties. Paradigm Medical Communications, LLC will not otherwise disclose personal information unless required to in a legal process. Paradigm Medical Communications, LLC staff members review individual test results to the extent necessary to record and track participants’ credits.
Contact Us
If you have any questions or comments, please email us at
© 2019 Paradigm Medical Communications, LLC except where noted. Content may not be reproduced in whole or part without the express written permission of Paradigm Medical Communications, LLC.