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Beyond the Guidelines: Investigator Perspectives on Current Clinical Issues and Ongoing Research in the Management of Early and Advanced Breast Cancer
Released August 2017

Proceedings from a CME symposium held at the 2017 ASCO Annual Meeting. Featuring perspectives from Kimberly L Blackwell, Julie R Gralow, Rita Nanda, Mark D Pegram, Hope S Rugo and Eric P Winer. (Video Program)

CE Disclosures and Faculty Information

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

    OVERVIEW OF ACTIVITY
    Breast cancer remains the most frequently diagnosed cancer in women, and in 2017 in the United States alone the disease will culminate in an estimated 255,180 new cases and 41,070 deaths. The current clinical management of breast cancer is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease (micro- or macroscopic) with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indication for and/or utility of these local and systemic treatment options are largely based on a number of prognostic and predictive risk factors present in the patient or 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 breast cancer. Although diagnosis and treatment remain in many ways more advanced for breast cancer than for 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 breast cancer management decisions in this dynamic clinical and research environment. However, in situations where multiple acceptable therapeutic options exist, such guidelines may not be particularly helpful at the time of decision-making. By exploring the perspectives of leading breast cancer clinical investigators regarding a number of clinical scenarios and a review of key data sets, this activity will assist medical oncologists, hematology-oncology fellows and other healthcare professionals in the development of evidence-based strategies for the treatment of breast cancer.

    LEARNING OBJECTIVES

    • Compare and contrast expert perspectives on breast cancer treatment recommendations, and use this information to refine or validate existing management strategies.
    • Appreciate the similarities and differences among existing genomic assays, and use this information to select an appropriate platform or platforms to assess risk and individualize therapy for patients with hormone receptor-positive breast cancer 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 breast cancer.
    • Implement a clinical plan for the management of metastatic HER2-positive breast cancer, incorporating existing and emerging targeted treatments.
    • Develop an evidence-based algorithm for the treatment of hormone-sensitive advanced breast cancer, including the use of endocrine, biologic and chemotherapeutic agents.
    • Recall the results of pivotal trials introducing effective new breast cancer therapeutic agents, and identify their potential impact on existing treatment algorithms.
    • Counsel appropriately selected patients with breast cancer 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 2.75 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, which includes participation in the evaluation component, enables the participant to earn up to 2.75 Medical Knowledge 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/ASCOBreast17/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:

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

    Advisory Committee: Advaxis Inc, Bayer HealthCare Pharmaceuticals, Eisai Inc, MacroGenics Inc, Merck, Novartis, Pfizer Inc, Pierian Biosciences, Syndax Pharmaceuticals Inc; Consulting Agreements: Celgene Corporation, Coherus Biosciences, G1 Therapeutics, Genentech BioOncology, Lilly, Novartis, Pfizer Inc, Puma Biotechnology Inc, Roche Laboratories Inc, Sandoz; Contracted Research: Celgene Corporation, Genentech BioOncology, Novartis, Pfizer Inc.

    Julie R Gralow, MD
    Professor, Medical Oncology
    Jill Bennett Endowed Professorship in Breast Cancer
    University of Washington School of Medicine
    Director, Breast Medical Oncology
    University of Washington School of Medicine/Seattle Cancer Care Alliance
    Member, Clinical Research Division
    Fred Hutchinson Cancer Research Center
    Seattle, Washington

    Advisory Committee: Pfizer Inc; Data and Safety Monitoring Board: Genentech BioOncology, Merck, Novartis; Steering Committee: Genentech BioOncology.

    Rita Nanda, MD
    Co-Director, Breast Medical Oncology
    Associate Professor of Medicine
    Section of Hematology/Oncology
    The University of Chicago
    Chicago, Illinois

    Advisory Committee: Celgene Corporation, Pfizer; Contracted Research: Celgene Corporation, Genentech BioOncology, Merck. 

    Mark D Pegram, MD
    Susy Yuan-Huey Hung Professor of Medicine
    Director of the Breast Oncology Program
    Co-Director, Translational Oncology Program
    Associate Director for Clinical Research
    Stanford Cancer Institute
    Stanford University School of Medicine
    Stanford, California

    Advisory Committee and Consulting Agreements: Amgen Inc, AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Novartis, Pfizer Inc, Roche Laboratories Inc.

    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: Amgen Inc, Eisai Inc, Genentech BioOncology, GlaxoSmithKline, Lilly, MacroGenics Inc, Merck, Novartis, OBI Pharma Inc, Pfizer Inc, Roche Laboratories Inc.

    Eric P Winer, MD
    Chief Strategy Officer
    Chief, Division of Women’s Cancers
    Director, Breast Oncology Center
    Susan F Smith Center for Women’s Cancers
    Thompson Chair in Breast Cancer Research
    Institute Physician 
    Professor of Medicine
    Harvard Medical School
    Dana-Farber Cancer Institute
    Boston, Massachusetts

    No relevant conflicts of interest to disclose.

    MODERATOR — Dr 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, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals 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, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals 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, a Pfizer Company, AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Genomic Health Inc, Lilly, Merck, Myriad Genetic Laboratories Inc, Novartis, Puma Biotechnology Inc and Tesaro Inc.

    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: August 2017
    Expiration date: August 2018

    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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