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Breast Cancer Update, Issue 2, 2016 (Video Program)
Released January 2017

Proceedings from video interviews with Drs Maura N Dickler, Matthew P Goetz and George W Sledge Jr on the treatment of breast cancer. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists, hematologists-oncologists and other healthcare providers 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 40,890 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 tumors, 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. To provide clinicians with therapeutic strategies to address the disparate needs of patients with BC, this program features information on the latest research developments and is designed to assist medical oncologists, hematologists-oncologists and other healthcare professionals with the formulation of up-to-date strategies for the care of patients with BC.

    LEARNING OBJECTIVES

    • Establish an evidence-based algorithm for the treatment of hormone-sensitive advanced BC, including the use of endocrine, biologic and chemotherapeutic agents.
    • Implement a long-term clinical plan for the management of metastatic HER2-positive BC, incorporating existing, recently approved and investigational targeted treatments.
    • Recognize the evolving application of biomarkers and multigene assays in BC management, and effectively use these tools to refine or individualize treatment plans for patients.
    • 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.

    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 1.5 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 1.5 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/BCU216/Video/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:

    Maura N Dickler, MD
    Interim Chief, Breast Medicine Service
    Associate Attending Physician
    Section Head, Endocrine Therapy Research Program
    Memorial Sloan Kettering Cancer Center
    Weill Cornell Medical College
    New York, New York

    Advisory Committee: Lilly; Consulting Agreements: AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc; Contracted Research: AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc.

    Matthew P Goetz, MD
    Professor of Oncology and Pharmacology
    Mayo Clinic
    Rochester, Minnesota

    Advisory Committee: Lilly; Consulting Agreement: Eisai Inc; Contracted Research: Genomic Health Inc, Lilly, Pfizer 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, Radius Health Inc, Symphogen A/S.

    EDITOR — 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, Agendia 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, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Therapeutics, 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, Tesaro Inc, 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 bioTheranostics Inc, Eisai Inc, Genentech BioOncology, Genomic Health Inc, Lilly and Novartis Pharmaceuticals Corporation.

    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: January 2017
    Expiration date: January 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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Watch video
(WIFI is recommended for best performance):
Early-stage breast cancer (BC) in the adjuvant and neoadjuvant settings
Topics:
  • MA17R: Extended adjuvant letrozole
  • MA17R extended adjuvant letrozole and long-term prognosis in hormone receptor (HR)-positive BC
  • Role of pertuzumab in early-stage, HER2-positive BC
  • Management of the axilla in patients with HER2-positive BC converted from clinically node-positive to node-negative after neoadjuvant therapy
  • Benefits of anthracycline-containing adjuvant therapy
Genomic assays and (neo)adjuvant treatment decision-making
Topics:
  • Role of the 21-gene Recurrence Score® in up-front decision-making regarding adjuvant chemotherapy
  • Role of genomic assays in treatment decision-making for neoadjuvant therapy
  • Role of the 21-gene signature assay for patients with invasive lobular carcinoma
  • Use of the 21-gene signature assay in HR-positive, node-positive BC
  • Perspective on the ASCO statement regarding the use of genomic assays for patients with node-positive disease
  • A 65-year-old woman with ER/PR-positive, HER2-negative infiltrating ductal carcinoma completes 5 years of tamoxifen, and a Breast Cancer Index assay indicates a low risk of distant recurrence
  • Use of genomic assays to refine treatment decision-making
  • MINDACT study of the 70-gene signature assay
Management of metastatic BC (mBC)
Topics:
  • A 49-year-old woman with recurrent HR-negative, HER2-positive mBC
  • Perspective on biosimilar agents and the HERITAGE study of a trastuzumab biosimilar
  • Incidence and clinical implications of ESR1 mutations in BC
  • Clinical utility of everolimus/exemestane in HR-positive mBC
  • Management of everolimus-associated pneumonitis
CDK4/6 inhibitors for the treatment of BC
Topics:
  • MONARCH 1: Results of a Phase II trial of the CDK4/6 inhibitor abemaciclib as monotherapy for ER-positive, HER2-negative mBC
  • Perspective on CDK4/6 inhibitors in HR-positive mBC
Novel approaches under investigation in BC
Topics:
  • Immune checkpoint inhibitors in triple-negative breast cancer
  • Novel PI3K inhibitors under investigation in mBC: Alpelisib and taselisib