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Current Controversies, Recent Developments and Emerging Strategies in the Practical Management of Breast Cancer
Released May 2013

Video excerpts from a clinical investigator Think Tank held on March 2, 2013. Featuring perspectives from Drs Adam M Brufsky, Lisa A Carey, William J Gradishar, Sara A Hurvitz, Monica Morrow, Ruth O’Regan, Edith A Perez and Hope S Rugo. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity has been designed to meet the educational needs of medical oncologists, hematologists, hematology-oncology fellows and other healthcare providers involved in the treatment of breast cancer.

    OVERVIEW OF ACTIVITY
    Breast cancer is one of the most rapidly evolving fields in medical oncology. Published results from ongoing clinical trials lead to the continuous emergence of new therapeutic agents and changes in the indications for existing treatments. In order to offer optimal patient care — including the option of clinical trial participation — clinicians must be well informed of these advances. To bridge the gap between research and practice, this program features leading oncology investigators debating the merits, applications and limitations of emerging data sets. By providing access to the latest research developments and expert perspectives, this CME program assists medical oncologists, hematologists and hematology-oncology fellows with the formulation of up-to-date clinical management strategies.

    LEARNING OBJECTIVES

    • Appropriately use biomarkers to assess risk and individualize therapeutic decision-making for patients with early breast cancer.
    • Develop evidence-based treatment approaches for patients diagnosed with HER2-positive breast cancer in the neoadjuvant, adjuvant and metastatic settings.
    • Formulate individualized approaches to later-line therapy for patients with HER2-negative metastatic breast cancer.
    • Assimilate new clinical trial evidence evaluating the use of mTOR inhibition to reverse endocrine resistance into the therapeutic algorithm for patients with progressive ER-positive metastatic breast cancer.
    • Evaluate recently presented data supporting the extended use of adjuvant tamoxifen beyond 5 years for patients with ER-positive early breast cancer and, where appropriate, integrate these findings into clinical practice.
    • 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.


    CME credit is no longer available for this issue

    CREDIT DESIGNATION STATEMENT

    CME credit is no longer available for this issue

    HOW TO USE THIS CME ACTIVITY

    This CME activity consists of a video component. The participant should watch the video.


    CME credit is no longer available for this issue

    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 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:

    Adam M Brufsky, MD, PhD
    Professor of Medicine, University of Pittsburgh
    Associate Director for Clinical Investigation
    University of Pittsburgh Cancer Institute
    Co-Director, Comprehensive Breast Cancer Center
    Associate Division Chief
    University of Pittsburgh, Department of Medicine
    Division of Hematology/Oncology
    Pittsburgh, Pennsylvania

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

    Lisa A Carey, MD
    Richardson and Marilyn Jacobs Preyer Distinguished Professor for Breast Cancer Research
    Chief, Division of Hematology and Oncology
    Physician-in-Chief
    North Carolina Cancer Hospital
    Associate Director for Clinical Research
    Lineberger Comprehensive Cancer Center
    Chapel Hill, North Carolina

    Advisory Committee, Consulting Agreements and Speakers Bureau: Amgen Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi; Research Support: Genentech BioOncology, GlaxoSmithKline, Sanofi.

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

    No real or apparent conflicts of interest to disclose.

    Sara A Hurvitz, MD
    Assistant Clinical Professor of Medicine
    University of California, Los Angeles
    Director, Breast Oncology Program
    Medical Director, Clinical Research Unit
    Jonsson Comprehensive Cancer Center
    Los Angeles, California

    Contracted Research: Boehringer Ingelheim Pharmaceuticals Inc, Eisai Inc,
    Genentech BioOncology, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc, Sanofi; Paid Travel: Novartis Pharmaceuticals Corporation.

    Monica Morrow, MD
    Anne Burnett Windfohr Chair of Clinical Oncology
    Chief of Breast Service
    Department of Surgery
    Memorial Sloan-Kettering Cancer Center
    Professor of Surgery
    Weill Medical College of Cornell University
    New York, New York

    No real or apparent conflicts of interest to disclose.

    Ruth O’Regan, MD
    Professor and Vice-Chair for Educational Affairs
    Department of Hematology and Medical Oncology
    Chief of Hematology and Medical Oncology
    Georgia Cancer Center for Excellence at Grady Memorial Hospital
    Louisa and Rand Glenn Family Chair in Breast Cancer Research
    Winship Cancer Institute of Emory University
    Atlanta, Georgia

    Advisory Committee: Celgene Corporation, Novartis Pharmaceuticals Corporation; Consulting Agreements: Novartis Pharmaceuticals Corporation, Roche Laboratories Inc; Contracted Research: Genentech BioOncology.

    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

    Contracted Research: Genentech BioOncology, Genomic Health Inc, GlaxoSmithKline.

    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

    Paid Research: Bristol-Myers Squibb Company, Celgene Corporation, Genentech BioOncology, GlaxoSmithKline, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc, Sanofi.

    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, Algeta US, Allos Therapeutics, Amgen Inc, ArQule Inc, Astellas, 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, EMD Serono Inc, Foundation Medicine Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly USA LLC, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc and Teva Oncology.

    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 grantors.

    This activity is supported by educational grants from AbbVie Inc, Eisai Inc, Genentech BioOncology, Genomic Health Inc 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: May 2013
    Expiration date: May 2014

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Watch video
(WIFI is recommended for best performance):

Metastatic HER2-negative disease
60 yo woman with multiple liver mets after TC → anastrozole for Stage III ER+HER2-neg IDC
64 yo woman with bone mets after CMF → tamoxifen for node-neg, ER+HER2-neg IDC
60 yo woman with ER+HER2-neg metastatic bone disease progressing on anastrozole
Recent paper (J Clin Oncol 2013;31(2):195-202) on negative temsirolimus trial
Phase III trial comparing capecitabine to eribulin in metastatic disease
PARP inhibitors in patients with BRCA mutations
51 yo woman presenting with primary ER+HER2-neg IDC and a lumbar spine met

HER2-positive metastatic disease
52 yo woman with dyspnea from ER-neg, HER2+ metastatic lymphangitic pulmonary mets
Current use of pertuzumab; recent Phase II trial of paclitaxel, pertuzumab, trastuzumab
More from CLEOPATRA trial: pertuzumab, trastuzumab, docetaxel
Ado-trastuzumab emtansine (T-DM1)

Adjuvant, pseudoadjuvant and neoadjuvant treatment
55 yo woman: 4-cm infiltrating lobular cancer who needs tumor shrinkage for lumpectomy
43 yo woman with a 2.5-cm breast mass and palpable node: ER/PR/HER2-neg IDC
44 yo woman with 5-mm DCIS who desires bilateral mastectomy
58 yo woman: 2.2-cm ER+HER2-neg IDC; 1 positive sentinel node; Ki-67: 8%
21-gene Recurrence Score® results in patients on NSABP-B-28 node-positive trial (AC alone or → paclitaxel)
48 yo woman with locally advanced breast cancer: ER-neg, HER2+
HERA and PHARE trials of duration of adjuvant trastuzumab
45 yo woman with in-breast “local recurrence” after lumpectomy
Case emailed for an opinion: 83 yo woman s/p mastectomy for 4.5-cm, Grade III ER/PR/HER2-neg IDC and 6 positive nodes
ATLAS trial of 5 vs 10 years of adjuvant tamoxifen