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Breast Cancer Update: Surgical Edition, Issue 1, 2017 (Video Program)
Released March 2017

Highlights from video interviews with Drs William J Gradishar, Tari King, Joseph A Sparano and Seema A Khan on the treatment of breast cancer. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for breast and general surgeons, surgical oncologists, surgical fellows and other healthcare providers involved in the treatment of breast cancer.

    OVERVIEW OF ACTIVITY
    Historically, surgery has been the primary mode of treatment for early breast cancer. The diagnostic, surgical and medical management of breast cancer, however, have escalated in complexity because of numerous advances in novel technologies and available adjunctive therapies. Hence, the multifaceted treatment of breast cancer now requires the input of an interdisciplinary group of expert care providers. This paradigm shift has created the challenge of ensuring that knowledge of major clinical advances in local and systemic breast cancer therapy is effectively disseminated among all members of the cross-functional team. To bridge the gap between research and patient care, Breast Cancer Update for Surgeons uses one-on-one interviews with leading breast cancer investigators to efficiently distill the latest research developments so they may be incorporated into clinical practice as appropriate. By providing access to cutting-edge data and expert perspectives, this CME program assists breast surgeons in the formulation of up-to-date clinical management strategies.

    LEARNING OBJECTIVES

    • Appreciate the information provided by genomic platforms to assess risk and individualize therapy for patients with ductal carcinoma in situ and early breast cancer.
    • Individualize the selection of evidence-based neoadjuvant and adjuvant chemobiologic regimens for patients with HER2-positive early breast cancer.
    • Describe the importance of adequate surgical margins in mitigating local recurrence risk for women with ductal carcinoma in situ treated with breast-conserving surgery and whole-breast irradiation.
    • Develop an evidence-based approach to the management of the axilla in patients with localized breast cancer and a positive sentinel lymph node biopsy.
    • Counsel appropriately selected patients with breast cancer about participation in ongoing clinical trials.

    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 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    ABS MAINTENANCE OF CERTIFICATION
    This activity provides Category 1 CME that may be used as self-assessment credit toward Part 2 of the American Board of Surgery MOC Program. It is the responsibility of each individual to remain apprised of the current requirements for his or her board-specific MOC Program. For more information about the ABS MOC Program, visit www.absurgery.org.

    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/BCUS117/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:

    William J Gradishar, MD
    Betsy Bramsen Professor of Breast Oncology and Professor of Medicine
    Deputy Director, Clinical Network
    Robert H Lurie Comprehensive Cancer Center of Northwestern University
    Director, Maggie Daley Center for Women’s Cancer Care
    Deputy Chief, Division of Hematology/Oncology
    Northwestern University Feinberg School of Medicine
    Chicago, Illinois

    No relevant conflicts of interest to disclose.

    Tari King, MD
    Chief, Breast Surgery
    Dana Farber/Brigham and Women’s Cancer Center
    Associate Division Chief for Breast Surgery
    Brigham and Women’s Hospital
    Associate Professor of Surgery
    Harvard Medical School
    Boston, Massachusetts

    No relevant conflicts of interest to disclose.

    Joseph A Sparano, MD
    Professor of Medicine and Women’s Health
    Albert Einstein College of Medicine
    Associate Chairman, Department of Oncology
    Montefiore Medical Center
    Bronx, New York

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Celgene Corporation, Genentech BioOncology, Merck, Novartis Pharmaceuticals Corporation, Pfizer Inc; Consulting Agreements: Celldex Therapeutics, Genentech BioOncology, Lilly; Contracted Research: Deciphera Pharmaceuticals LLC, Eisai Inc, Genentech BioOncology, MedImmune Inc, Merck, Novartis Pharmaceuticals Corporation, Prescient Therapeutics; Ownership Interest: MetaStat Inc.

    Seema A Khan, MD, MPH
    Professor of Surgery
    Bluhm Family Professor of Cancer Research
    Northwestern University Feinberg School of Medicine
    Chicago, Illinois

    No relevant conflicts of interest to disclose.

    EDITORDr 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 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, 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, 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 grantor.

    This activity is supported by an educational grant from Genomic Health 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: March 2017
    Expiration date: March 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):
Use of genomic assays to assist in clinical decision-making for patients with ER-positive early breast cancer (BC)
Topics:
  • Critical evaluation of the MINDACT trial results
  • MINDACT trial: Utility of the 70-gene signature in selecting patients with BC and 0 to 3 positive nodes for adjuvant chemotherapy
  • Case discussion: A 58-year-old woman with T1cN1, ER-positive, HER2-negative BC and a 21-gene assay Recurrence Score (RS) of 12
  • Case discussion: A 42-year-old woman with strongly ER/PR-positive, HER2-negative, node-negative multifocal infiltrating ductal carcinoma (IDC) and a 21-gene RS of 19
  • Use of the 21-gene RS to guide neoadjuvant therapy decision-making
  • Case discussion: A 47-year-old premenopausal woman with Stage IIB (T2N1M0) ER/PR-positive, HER2-negative IDC and a 21-gene RS of 13 elects to receive endocrine therapy alone
  • TAILORx: Results from the low-risk registry of a prospective trial of adjuvant systemic therapy based on the 21-gene RS for patients with ER-positive, HER2-negative BC
  • Results of the Phase III West German Study Group PlanB trial: Significance of the 21-gene RS and concordance of prognostic markers in ER-positive, HER2-negative, high-risk node-negative and node-positive BC
  • Results of a prospective registry of patients with early BC for whom treatment decisions in clinical practice were made incorporating the 21-gene RS
  • BC-specific survival for patients with ER-positive, node-negative invasive BC and 21-gene signature results in the SEER database
  • Case discussion: A 52-year-old postmenopausal woman with ER/PR-positive, HER2-negative, node-negative IDC and an RS of 12 undergoes breast-conserving surgery (BCS)
Tailoring treatment for patients with ductal carcinoma in situ (DCIS)
Topics:
  • Consensus guidelines on margins for BCS with whole breast irradiation in patients with DCIS
  • Benefits and limitations of the DCIS Score
  • Use of the DCIS Score as a tool for identifying risk of BC recurrence and to facilitate decision-making regarding radiation therapy
Timing and role of sentinel lymph node biopsy (SLNB)
Topics:
  • Viewpoint on performing SLNB before the administration of neoadjuvant chemotherapy
  • SLNB after neoadjuvant chemotherapy in patients with node-negative versus node-positive BC
  • Second opinion: Role of SLNB in the setting of recurrent BC
Other issues in the treatment of early BC: Maintaining fertility and use of adjuvant bisphosphonates
Topics:
  • Fertility issues in early BC
  • Adjuvant bisphosphonates for early BC
Treatment of HER2-positive and triple-negative BC
Topics:
  • Case discussion: A 37-year-old woman with a 3.5-cm ER/PR-low, HER2-positive, clinically node-negative BC
  • Case discussion: A man in his late thirties presents with neglected locally advanced, ER-positive, HER2-positive BC
  • Second opinion: Surgical resection of an intact primary tumor in a 49-year-old woman with ER/PR-negative, HER2-positive metastatic BC after complete response of a solitary liver metastasis to paclitaxel/trastuzumab/ pertuzumab
  • Case discussion: A 36-year-old woman with a 4-cm triple-negative IDC who desires BCS receives neoadjuvant cisplatin on a clinical trial
  • Effect of ER and HER2 status on the use of neoadjuvant chemotherapy
  • Targeting the androgen receptor in patients with triple-negative BC