For the second issue of this new series, Dr Neil Love conducted 2 one-on-one interviews — with an oncology nurse practitioner and a leading clinical investigator — to gain practical perspectives on perhaps the most rapidly changing area in breast cancer management, HER2-positive disease. Featuring approximately 1 hour of discussion, this content is available in a number of formats for listening on the go with a mobile device or on a computer and is designed to better prepare oncology nurses, clinical nurse specialists and nurse practitioners to both educate and care for their patients with this evermore treatable form of the disease.

• TOPICS DISCUSSED

	Joan MS Armstrong, MSN, APRN-BC Nurse Practitioner Breast Medical Oncology University of Michigan Comprehensive Cancer Center Adjunct Faculty University of Michigan School of Nursing Ann Arbor, Michigan		INTERVIEW WITH MS ARMSTRONG Case discussion: A 51-year-old woman with HER2-positive metastatic breast cancer and CNS metastasis - Continuation of anti-HER therapy beyond disease progression - Treatment of patients with CNS metastases - Management of side effects associated with lapatinib Case discussion: A patient with ER-positive, HER2-positive breast cancer and metastases to the lung, brain, liver and lymph nodes - Importance of rebiopsying sites of metastatic disease - Mechanism of action of trastuzumab emtansine (T-DM1) - Tolerability of T-DM1 Neoadjuvant therapeutic options for patients with locally advanced HER2-positive breast cancer Tolerance of TCH in younger versus older patients Selection of anthracycline- and nonanthracycline-containing adjuvant regimens for patients with HER2-positive breast cancer
	Lisa A Carey, MD Preyer Distinguished Professor in Breast Cancer Research Medical Director UNC Breast Center UNC Lineberger Comprehensive Cancer Center Division of Hematology/Oncology Chapel Hill, North Carolina		INTERVIEW WITH DR CAREY Case discussion: A 36-year-old woman with ER-negative, HER2-positive breast cancer initially treated with preoperative chemotherapy/trastuzumab on the CALGB-40601 trial - Incidence of anthracycline-associated leukemias Case discussion: A 71-year-old woman with Stage III, ER-negative, HER2-positive breast cancer who refused radiation and systemic therapy after lumpectomy - Family support and patient coping with breast cancer and its treatment - Importance of education for patients receiving capecitabine/lapatinib - Side effects associated with capecitabine/lapatinib - Long-term response and side effects seen with T-DM1/pertuzumab on a clinical trial Similarities and differences in the mechanisms of action of trastuzumab and pertuzumab Recent FDA approval of pertuzumab in combination with docetaxel and trastuzumab for patients with HER2-positive metastatic disease Initial results from the Phase III EMILIA trial evaluating T-DM1 versus capecitabine/lapatinib in patients with HER2-positive locally advanced or metastatic breast cancer previously treated with trastuzumab and a taxane Cost and reimbursement considerations with the use of dual anti-HER2 therapies
	EDITOR: Neil Love, MD Research To Practice Miami, Florida

Breast cancer is one of the most rapidly evolving fields in oncology nursing. Although overlap exists with regard to a number of treatment-related issues and phenotypic presentation (eg, presence or absence of estrogen and/or progesterone receptors and HER2 status), each of these distinct disease subtypes has its own diagnostic, management and supportive care considerations and challenges that warrant education and discussion. As such it is quite rational and in some ways preferable to undertake education focused on 1 specific phenotype rather than breast cancer in its entirety.

In this regard and among the 3 phenotypes, HER2-positive breast cancer perhaps stands alone in terms of educational need as the continuing emergence of new and critical data sets seemingly transforms clinical management on an almost daily basis. To provide oncology nurses with therapeutic strategies to address the disparate needs of patients with HER2-positive breast cancer, the Oncology Nursing Update audio series employs one-on-one interviews with medical oncologists and nurses with expertise in the field. Upon completion of this CNE activity, oncology nurses should be able to formulate an up-to-date and more complete approach to the care of patients with HER2-positive breast cancer.

LEARNING OBJECTIVES

• Discuss the benefits and risks associated with evidence-based systemic therapies used in the treatment of HER2-positive breast cancer, including chemotherapy and HER2-targeted therapies.
• Develop a plan of care to manage the side effects associated with these therapies to support quality of life and continuation of treatment.
• Evaluate the preliminary safety profiles and response outcomes observed in studies of novel and newly approved anti-HER2 targeted agents for patients with locally advanced and metastatic HER2-positive disease.
• Identify opportunities to enhance the collaborative role of oncology nurses in the comprehensive biopsychosocial care of patients with breast cancer.

ACCREDITATION STATEMENT

Research To Practice is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

CREDIT DESIGNATION STATEMENT

This educational activity for 1.5 contact hours is provided by Research To Practice during the period of December 2012 through December 2013.

HOW TO USE THIS CNE ACTIVITY

This is an audio CNE program. This website contains CNE information, including learning objectives, faculty disclosures, a Post-test and an Educational Assessment and Credit Form, as well as links to relevant abstracts and full-text articles.

To receive credit, participants should read the learning objectives and faculty disclosures, listen to the audio MP3s and complete the Post-test and Educational Assessment and Credit Form located at ResearchToPractice.com/ONUBreast112/CNE. A statement of CNE credit will be issued only upon completion of the Post-test, with a score of 75% or better, and the Educational Assessment and Credit Form. Your statement of credit will be mailed to you within 3 weeks or may be printed online.

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 CNE 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 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:

Joan M Armstrong, MSN, APRN-BC
Nurse Practitioner, Breast Medical Oncology
University of Michigan Comprehensive Cancer Center
Adjunct Faculty, University of Michigan School of Nursing
Ann Arbor, Michigan

Speakers Bureau: Amgen Inc, Celgene Corporation, Genomic Health Inc, Novartis Pharmaceuticals Corporation.

Lisa A Carey, MD
Preyer Distinguished Professor in Breast Cancer Research
Medical Director, UNC Breast Center
UNC Lineberger Comprehensive Cancer Center
Division of Hematology/Oncology
Chapel Hill, North Carolina

No financial interests or affiliations to disclose.

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: Abbott Laboratories, 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 grantor.

This activity is supported by an educational grant from Genentech BioOncology.

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

There is no implied or real endorsement of any product by RTP or the American Nurses Credentialing Center.