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Dissecting the Decision: Investigators Discuss Available Research Data and Clinical Factors That Shape the Management of HER2-Positive Breast Cancer
Released September 2014

Proceedings from a CME symposium held at the 2014 ASCO Annual Meeting. Featuring perspectives from Drs Harold J Burstein, Edith A Perez, Kimberly L Blackwell, Mark D Pegram and Fabrice André. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists, hematology-oncology fellows and other allied healthcare professionals involved in the treatment of breast cancer.

    Breast cancer remains the most frequently diagnosed cancer in women, and in 2014 in the United States alone it is estimated the disease will culminate in 232,670 new cases and 40,000 deaths. Patients with HER2-positive disease account for 15% to 20% of all breast cancer cases, or approximately 35,000 to 46,000 new patients per year. In 1987 amplification of the HER2 oncogene was determined to result in reduced survival in breast cancer, which triggered the development of trastuzumab as the first targeted therapy based on a molecular cancer abnormality. Over the ensuing quarter century significant advances have been made in the understanding of the biology and the clinical management of HER2-positive breast cancer.

    However, considerable gaps remain in optimizing treatment of this disease subtype, particularly with the growing armamentarium of effective HER2-targeted agents. In the treatment of early-stage HER2-positive breast cancer several issues remain incompletely elucidated, including who should receive neoadjuvant versus adjuvant therapy, the use of single versus dual anti-HER2 blockade, the use of anthracycline- versus nonanthracyline-containing chemotherapy and the approach to therapy for patients with small, node-negative disease. In the advanced disease setting several clinical questions remain open, including the optimal sequencing of treatments in the first, second and later lines of treatment, the timing and duration of treatment, how previous adjuvant HER2-targeted therapy influences treatment decision-making, how hormone receptor status can affect therapeutic options and how best to manage brain metastases, which occur in approximately 50% of patients with metastatic HER2-positive disease. In addition to the preceding issues, HER2 test results are discordant between primary and metastatic disease for 5% to 10% of patients, necessitating management approaches that may have a significant impact on treatment.

    By providing access to the latest research developments and expert perspectives on the treatment of HER2-positive breast cancer in the neoadjuvant, adjuvant and metastatic settings, these proceedings from a case-based CME symposium held at the 2014 ASCO Annual Meeting aim to assist medical oncologists, breast surgeons and other healthcare providers as they attempt to formulate optimal disease management strategies in the face of a constantly evolving body of knowledge.


    • Compare and contrast expert perspectives on HER2-positive breast cancer treatment recommendations, and use this information to refine or validate existing management strategies.
    • Individualize the selection of evidence-based neoadjuvant and adjuvant systemic regimens for patients with HER2-overexpressing early breast cancer.
    • Implement a clinical plan for the management of advanced HER2-positive breast cancer, incorporating existing and emerging targeted treatments.
    • Develop an evidence-based algorithm for the treatment of advanced hormone receptor-positive, HER2-positive premenopausal and postmenopausal breast cancer, including the use of endocrine, biologic and chemotherapeutic agents.
    • Communicate the availability of ongoing clinical trials evaluating novel anti-HER2 strategies, and counsel appropriately selected patients about study participation.

    Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    CME credit is no longer available for this issue


    CME credit is no longer available for this issue

    This CME activity consists of a video component. To receive credit, the participant should watch the video.

    CME credit is no longer available for this issue

    Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CME activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

    FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Harold J Burstein, MD, PhD
    Associate Professor of Medicine
    Harvard Medical School
    Breast Oncology Center
    Dana-Farber Cancer Institute
    Boston, Massachusetts

    No real or apparent conflicts of interest to disclose.

    Edith A Perez, MD
    Deputy Director at Large
    Mayo Clinic Cancer Center
    Group Vice Chair
    Alliance of Clinical Trials in Oncology
    Serene M and Frances C Durling Professor of Medicine
    Mayo Clinic
    Jacksonville, Florida

    No real or apparent conflicts of interest to disclose.

    Kimberly L Blackwell, MD
    Professor of Medicine
    Director, Breast Cancer Program
    Duke Cancer Institute
    Durham, North Carolina

    Advisory Committee: Amgen Inc, Roche Laboratories Inc; Consulting Agreements: Boehringer Ingelheim Pharmaceuticals Inc, Genentech BioOncology, Novartis Pharmaceuticals Corporation; Contracted Research: Celgene Corporation, Genentech BioOncology; Speakers Bureau: Genomic Health Inc.

    Mark D Pegram, MD
    Susy Yuan-Huey Hung Professor of Medicine
    Director of the Breast Oncology Program
    Director, Molecular Therapeutics Program
    Stanford Cancer Institute
    Stanford University School of Medicine
    Stanford, California

    Consulting Agreements: Celgene Corporation, Cepheid, Genentech BioOncology, Shionogi Inc.

    Fabrice André, MD, PhD
    Professor, Department of Medical Oncology
    Institut Gustave Roussy
    Villejuif, France

    Advisory Committee: Astellas, AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals Corporation; Contracted Research: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals Corporation, Pfizer Inc; Speakers Bureau: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals Corporation.

    CONSULTING ONCOLOGISTS — The following consulting oncologists (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Patricia A DeFusco, MD
    Clinical Assistant Professor of Medicine
    University of Connecticut School of Medicine
    Director, Hartford Hospital Breast Program
    Physician Leader
    Hartford Healthcare Cancer Institute
    Breast Disease Management Team
    Hartford, Connecticut

    Contracted Research: Genentech BioOncology, Genomic Health Inc, Roche Laboratories Inc.

    Leon H Dragon, MD
    Kellogg Cancer Center
    Highland Park, Illinois
    NorthShore University HealthSystem
    Senior Clinician Educator
    University of Chicago
    Pritzker School of Medicine
    Chicago, Illinois

    No real or apparent conflicts of interest to disclose.

    Bonni L Guerin, MD
    Director of Breast Cancer Treatment and Prevention
    Overlook Medical Center
    Summit, New Jersey

    Speakers Bureau: Celgene Corporation, Genomic Health Inc.

    Carolyn B Hendricks, MD
    The Center for Breast Health
    Bethesda, Maryland

    No real or apparent conflicts of interest to disclose.

    Kert D Sabbath, MD
    Smilow Cancer Hospital
    Harold Leever Regional Cancer Center
    Waterbury, Connecticut

    No real or apparent conflicts of interest to disclose.

    MODERATORDr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Amgen Inc, Astellas, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals Inc, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc, Teva Oncology and VisionGate Inc.

    RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

    This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantor.

    This activity is supported by an educational grant from Genentech BioOncology.

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    Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
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    Last review date: September 2014
    Expiration date: September 2015

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