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Second Opinion: Investigator Perspectives on Current Cases, Clinical Issues and Ongoing Research in the Management of Breast Cancer
Released September 2016

Proceedings from a CME symposium held at the 2016 ASCO Annual Meeting. Featuring perspectives from Drs Angelo Di Leo, Joyce O’Shaughnessy, Hope S Rugo, George W Sledge Jr and Sara M Tolaney. (Video Program)

CE Disclosures and Faculty Information

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

    OVERVIEW OF ACTIVITY
    BC remains the most frequently diagnosed cancer in women, and in 2016 in the United States alone the disease will culminate in an estimated 246,660 new cases and 40,450 deaths. The current clinical management of BC is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indication and/or utility of these local and systemic treatment options is largely based on a number of prognostic and predictive risk factors present within the patient or her tumor at the time of diagnosis. In fact, as the field of oncology is challenged to improve the precision with which it therapeutically targets malignant cells, biomarker-driven treatment algorithms have become the “norm” for many tumor types, particularly BC. Although the diagnosis and treatment of BC remain, in many ways, more advanced than in other solid cancers, challenging issues in the basic management of this disease continue to require refinement.

    Several consensus- and evidence-based treatment guidelines are available and aim to assist clinicians with making BC management decisions in the face of this dynamic clinical and research environment, but despite the existence of these tools many areas of controversy persist within academic and community settings. By using the perspectives of leading BC clinical investigators regarding a number of questions and cases provided by a panel of community-based oncologists as well as a review of key data sets that support this case-based discussion, this activity will assist medical oncologists, hematology-oncology fellows and other healthcare professionals in the development of evidence-based strategies for the treatment of BC.

    LEARNING OBJECTIVES

    • Appraise recent data on therapeutic advances and changing practice standards in early and advanced BC, and integrate this information, as appropriate, into current clinical care.
    • Consider the use of available biomarkers and genomic assays to assess risk and individualize therapy for patients in the neoadjuvant, adjuvant and extended-adjuvant settings.
    • Individualize the selection of evidence-based neoadjuvant and adjuvant chemobiologic regimens for patients with HER2-overexpressing early BC.
    • Implement a long-term clinical plan for the management of metastatic HER2-positive BC, incorporating existing, recently approved and investigational targeted treatments.
    • Develop an evidence-based algorithm for the treatment of hormone-sensitive advanced BC, including the use of endocrine, biologic and chemotherapeutic agents.
    • Recognize the recent FDA approval of palbociclib for ER-positive metastatic BC, and discern how this agent can be optimally integrated into clinical practice.
    • Develop an understanding of the mechanisms of action, available data and potential clinical roles of late-stage investigational compounds in preparation for their potential introduction into BC clinical practice.
    • Appraise the rationale for and clinical data with investigational anti-PD-1 and anti-PD-L1 antibodies for patients with metastatic BC.
    • Counsel appropriately selected patients with BC about participation in ongoing clinical trials investigating novel therapeutic agents and strategies.

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

    CREDIT DESIGNATION STATEMENT
    Research To Practice designates this enduring material for a maximum of 2.25 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) — MAINTENANCE OF CERTIFICATION (MOC)
    Successful completion of this CME activity enables the participant to earn up to 2.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Please note, this program has been specifically designed for the following ABIM specialty: medical oncology.

    Personal information and data sharing: Research To Practice aggregates deidentified user data for program-use analysis, program development, activity planning and site improvement. We may provide aggregate and deidentified data to third parties, including commercial supporters. We do not share or sell personally identifiable information to any unaffiliated third parties or commercial supporters. Please see our privacy policy at ResearchToPractice.com/Privacy-Policy for more information.

    HOW TO USE THIS CME ACTIVITY
    This CME activity consists of a video component. To receive credit, the participant should watch the video, complete the Post-test with a score of 80% or better and fill out the Educational Assessment and Credit Form located at ResearchToPractice.com/ASCOBreast16/CME.

    CONTENT VALIDATION AND DISCLOSURES
    Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CME activities. 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 relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Angelo Di Leo, MD, PhD
    Head of Sandro Pitigliani Medical Oncology Unit
    Department of Oncology
    Hospital of Prato
    Istituto Toscano Tumori
    Prato, Italy

    Advisory Committee: Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Eisai Inc, Lilly, Pfizer Inc, Roche Laboratories Inc; Consulting Agreements: AstraZeneca Pharmaceuticals LP, Genomic Health Inc, Lilly, Pfizer Inc, Roche Laboratories Inc.

    Joyce O’Shaughnessy, MD
    Chair, Breast Cancer Research Program
    Baylor-Charles A Sammons Cancer Center
    Texas Oncology
    US Oncology
    Dallas, Texas

    Consulting Agreements: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Eisai Inc, Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc, Sanofi, Takeda Oncology.

    Hope S Rugo, MD
    Professor of Medicine
    Director, Breast Oncology and Clinical Trials Education
    University of California, San Francisco
    Helen Diller Family Comprehensive Cancer Center
    San Francisco, California

    Contracted Research: Eisai Inc, Genentech BioOncology, GlaxoSmithKline, Lilly, MacroGenics Inc, Merck, Novartis Pharmaceuticals Corporation, Pfizer Inc, Plexxikon Inc, Roche Laboratories Inc; Speakers Bureau: Genomic Health Inc.

    George W Sledge Jr, MD
    Professor of Medicine
    Chief, Division of Oncology
    Department of Medicine
    Stanford University School of Medicine
    Stanford, California

    Board of Directors: Syndax Pharmaceuticals Inc; Contracted Research: Lilly; Scientific Advisory Board: Nektar, Radis Health Inc, Symphogen A/S.

    Sara M Tolaney, MD, MPH
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Assistant Professor in Medicine
    Harvard Medical School
    Boston, Massachusetts

    Contracted Research: Genentech BioOncology, Lilly, Merck, Novartis Pharmaceuticals Corporation, Pfizer Inc.

    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, Acerta Pharma, Agendia Inc, Amgen Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Teva Oncology, Tokai Pharmaceuticals Inc and VisionGate Inc.

    RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no relevant 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 grantors.

    This activity is supported by educational grants from AbbVie Inc, Agendia Inc, Astellas Pharma Global Development Inc/Medivation Inc, Celgene Corporation, Genentech BioOncology and Lilly.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
    Adobe Flash Player 10.2 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Last review date: September 2016
    Expiration date: September 2017

    After completing the Post-test, learners may download and review the answers here in order to identify further areas of study.

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