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Visiting Professors: Improving the Efficacy of Endocrine Treatment of Metastatic Breast Cancer
Released September 2018

Featuring perspectives from Dr Sara M Tolaney. (Video Program)

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists and other healthcare providers involved in the treatment of ER-positive metastatic breast cancer (mBC).

    OVERVIEW OF ACTIVITY
    Among the widely acknowledged BC phenotypes, ER-positive disease, which represents approximately 63% of all cases, is perhaps the most nuanced with regard to therapeutic decision-making in the advanced disease setting. Specifically, unlike other phenotypes for which systemic therapy almost always includes chemotherapy, for patients with hormonally driven tumors, the availability of effective endocrine therapy may initially abrogate and significantly delay the need for cytotoxic intervention. Although this and various other factors have historically defined the management of ER-positive mBC, several groundbreaking advances have added greater complexity to this prevalent clinical situation. Specifically, improved understanding of the mechanisms by which breast tumors develop resistance to endocrine therapy has led to the appreciation that several other biologic pathways may be implicated in this process and has in turn fostered a spate of clinical research designed to evaluate novel therapies with inhibitory activity against these potential targets. Significantly, the results of these efforts have now been actualized in the clinic as over the past several years the FDA has granted approval to several unique treatments that, when combined with hormonal therapy, have been shown to enhance efficacy over endocrine intervention alone. Importantly, although the availability of these therapies undoubtedly provides immense benefit to patients, the many related issues (eg, sequencing, side effects) have increased the demands placed on clinicians and created additional areas of uncertainty.
    To bridge this gap between research and patient care, this video presentation by Dr Sara M Tolaney uses a review of recent relevant publications and presentations, ongoing clinical trials and clinical investigator treatment preferences to assist medical oncologists and other healthcare providers involved in the treatment of ER-positive mBC with the formulation of up-to-date clinical management strategies.

    LEARNING OBJECTIVES

    • Individualize the selection and sequence of systemic therapy for patients with newly diagnosed mBC, considering clinical presentation (eg, age, menopausal status, comorbidities, symptomatology) and prior treatment course (eg, de novo metastatic disease, type and duration of adjuvant therapy).
    • Describe known and proposed mechanisms of resistance to hormonal therapy, and identify available therapies and investigational efforts attempting to leverage this knowledge.
    • Recognize the FDA approvals of palbociclib, ribociclib and abemaciclib for ER-positive mBC, and discern how these agents can be optimally employed in nonresearch patient care.
    • Educate patients regarding the unique side effects associated with approved CDK4/6 inhibitors, and develop preventive and emergent strategies to reduce or ameliorate these toxicities.
    • Identify clinical situations in which endocrine therapy alone or in combination with HER2-directed therapy should be considered in the management of ER-positive, HER2-positive mBC.

    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 AMA PRA Category 1 Credit™. 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 1 Medical Knowledge MOC point 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 this 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 review the CME information, 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/GrandRoundsMetastaticBC18/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:

    Presenting Faculty Member

    Sara M Tolaney, MD, MPH
    Dana-Farber Cancer Institute
    Associate Director of Clinical Research
    Susan F Smith Center for Women’s Cancers
    Senior Physician
    Assistant Professor in Medicine
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee and Consulting Agreements: AstraZeneca Pharmaceuticals LP, Merck, NanoString Technologies, Nektar, Puma Biotechnology Inc; Contracted Research: AstraZeneca Pharmaceuticals LP, Exelixis Inc, Genentech, Lilly, Merck, Nektar, Novartis, Pfizer Inc.

    Project Steering Committee Members

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

    Consulting Agreements: Amgen Inc, AstraZeneca Pharmaceuticals LP, Celgene Corporation, Eisai Inc, Genentech, Lilly, Merck, Novartis, Pfizer Inc, Roche Laboratories Inc, Spectrum Pharmaceuticals Inc.

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

    Advisory Committee: ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company; Paid Research: Lilly, Pfizer Inc.

    Sara A Hurvitz, MD
    Associate Professor of Medicine
    Director, Breast Oncology Program, Division of Hematology/Oncology
    University of California, Los Angeles
    Medical Director, Jonsson Comprehensive Cancer Center Clinical Research Unit
    Los Angeles, California
    Co-Director, Santa Monica-UCLA Outpatient Oncology Practices
    Santa Monica, California

    Paid Research: Ambryx Inc, Amgen Inc, BioMarin, Boehringer Ingelheim Pharmaceuticals Inc, Cascadian Therapeutics, Daiichi Sankyo Inc, Dignitana AB, Genentech, GlaxoSmithKline, Lilly, MacroGenics Inc, Medivation Inc, a Pfizer Company, Merrimack Pharmaceuticals Inc, Novartis, OBI Pharma Inc, Pfizer Inc, Pieris Pharmaceuticals Inc, Puma Biotechnology Inc, Roche Laboratories Inc, Seattle Genetics; Paid Travel: Lilly, Novartis, OBI Pharma Inc.

    Ian E Krop, MD, PhD
    Director of Clinical Research
    Breast Oncology Center
    Dana-Farber Cancer Institute
    Chief, Breast Oncology Center
    Susan F Smith Center for Women’s Cancers
    Associate Professor of Medicine, Harvard Medical School
    Boston, Massachusetts

    Advisory Committee and Contracted Research: Genentech, Roche Laboratories Inc; Consulting Agreement: Daiichi Sankyo Inc; Spouse Employment/Salary, Ownership Interest and Leadership Role: AMAG Pharmaceuticals.

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

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Daiichi Sankyo Inc, Eisai Inc, Lilly, Merck, Novartis, Pfizer Inc, Roche Laboratories Inc, Sanofi Genzyme; Consulting Agreements: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Daiichi Sankyo Inc, Eisai Inc, Genomic Health Inc, Lilly, Merck, Novartis, Pfizer Inc, Roche Laboratories Inc, Sanofi Genzyme; Contracted Research: 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, Lilly, MacroGenics Inc, Merck, Novartis, OBI Pharma Inc, Pfizer Inc, Plexxikon Inc, Roche Laboratories Inc; Paid Travel: Lilly, Mylan NV, Puma Biotechnology Inc.

    Denise A Yardley, MD
    Senior Investigator, Breast Cancer Research
    Sarah Cannon Research Institute
    Tennessee Oncology PLLC
    Nashville, Tennessee

    Advisory Committee, Contracted Research and Speakers Bureau: Genentech, Novartis.

    EDITOR — Dr Love is president and CEO of Research To Practice. Research To Practice receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Acerta Pharma — A member of the AstraZeneca Group, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech, Genomic Health Inc, Gilead Sciences Inc, Guardant Health, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, Natera Inc, Novartis, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sandoz Inc, a Novartis Division, Sanofi Genzyme, Seattle Genetics, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals Inc.

    RESEARCH TO PRACTICE CME PLANNING COMMITTEE MEMBERS, STAFF AND REVIEWERS — Planners, scientific staff and independent reviewers for Research To Practice have no relevant conflicts of interest to disclose.

    This educational activity contain 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 Lilly.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
    Adobe Flash Player 27 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Release date: September 2018
    Expiration date: September 2019

    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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