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Addressing Current Questions and Controversies in the Management of Early and Advanced Breast Cancer
Released January 2019

Proceedings from a satellite symposium during the 41st annual San Antonio Breast Cancer Symposium. Featuring perspectives from Dr Harold J Burstein, Dr William J Gradishar, Dr Joyce O’Shaughnessy, Dr Hope S Rugo, Prof Peter Schmid and Dr Debu Tripathy. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists, breast cancer surgeons, radiation oncologists and other healthcare professionals involved in the diagnosis and treatment of breast cancer (BC).

    The current clinical management of breast cancer 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. Increasingly, an emphasis is being placed on a “personalized medicine” approach that promises to more effectively identify specific treatments that will benefit individuals based on specific patient- and disease-related characteristics. In conjunction with this approach, researchers are developing novel agents and immunotherapeutic strategies with the aim of enhancing the efficacy of existing treatments or overcoming resistance to endocrine therapy, chemotherapy or biologic agents. The pace of change in the field of breast medical oncology has been rapid, creating an important need for education about the unique mechanisms of action, toxicities and effectiveness of novel agents to properly prepare clinicians for their appropriate use in clinical practice. Several consensus- and evidence-based treatment guidelines are available and aim to assist clinicians with making breast cancer 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.

    These proceedings from a CME symposium during the San Antonio Breast Cancer Symposium explore significant therapeutic advances by using the perspectives of leading breast cancer experts on challenging cases and questions submitted by clinicians in the community to frame a relevant discussion of how this information has aided in the refinement of current routine clinical practice and ongoing research. This CME activity will help medical oncologists and other healthcare professionals find answers to the individualized questions and concerns that they frequently encounter and in turn provide high-quality cancer care.


    • Consider published data to guide the use of biomarkers and genomic classifiers to assess risk and customize therapy for patients with hormone receptor-positive BC in the adjuvant and extended-adjuvant settings.
    • Appraise available and emerging research evidence to individualize the selection and duration of neoadjuvant, adjuvant and/or extended-adjuvant therapy for patients with HER2-overexpressing early BC.
    • Develop an evidence-based algorithm for the treatment of advanced hormone receptor-positive pre- and postmenopausal BC, including the use of endocrine, biologic and chemotherapeutic agents.
    • Implement a long-term clinical plan for the care of patients with metastatic HER2-positive BC, incorporating existing and investigational targeted treatments.
    • Appreciate the biologic rationale for, available data with and ongoing evaluation of novel immunotherapeutic approaches in preparation for their potential introduction into BC clinical practice.
    • Appraise published efficacy and safety data with the use of PARP inhibitors in patients with metastatic BC harboring a BRCA1/2 mutation, and consider the diagnostic and therapeutic implications of these findings on clinical care.
    • Develop an understanding of the mechanisms of action of, available data with and potential clinical roles of other investigational compounds to facilitate referral for clinical trial opportunities or participation in expanded access programs.

    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

    CME credit is no longer available for this issue

    This CME activity consists of a video component.
    CME credit is no longer available for this issue

    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:

    Harold J Burstein, MD, PhD
    Associate Professor of Medicine
    Harvard Medical School
    Breast Oncology Center
    Dana-Farber Cancer Institute
    Boston, Massachusetts

    No relevant conflicts of interest to disclose.

    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
    Interim Chief, Division of Hematology/Oncology
    Northwestern University Feinberg School of Medicine
    Chicago, Illinois

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Pfizer Inc; Data and Safety Monitoring Board: Genentech, Seattle Genetics.

    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.

    Professor Peter Schmid, MD, PhD
    Centre Lead
    Centre for Experimental Cancer Medicine
    Barts Cancer Institute
    London, United Kingdom

    Advisory Committee: Astra Zeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Genentech, Lilly, Merck, Novartis, Pfizer Inc, Puma Biotechnology Inc, Roche Laboratories Inc, Seattle Genetics; Consulting Agreements: Astra Zeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals Inc, Celgene Corporation, Eisai Inc, Genentech, Lilly, Merck, Novartis, Pfizer Inc, Puma Biotechnology Inc, Roche Laboratories Inc, Seattle Genetics; Contracted Research: Astellas Pharma Global Development Inc, Astra Zeneca Pharmaceuticals LP, Genentech, Medivation Inc, a Pfizer Company, Novartis, OncoGenex Pharmaceuticals Inc, Roche Laboratories Inc; Employment (Spouse): Genentech, Roche Laboratories Inc.

    Debu Tripathy, MD
    Professor and Chair
    Department of Breast Medical Oncology
    The University of Texas
    MD Anderson Cancer Center
    Houston, Texas

    Advisory Committee: Puma Biotechnology Inc; Consulting Agreements: Novartis, Pfizer Inc; Contracted Research: Novartis.

    CONSULTING ONCOLOGISTS — The following consulting oncologists (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Laila Agrawal, MD
    Norton Healthcare
    Louisville, Kentucky

    No relevant conflicts of interest to disclose.

    Alan Astrow, MD
    NewYork-Presbyterian Brooklyn Methodist Hospital
    Professor of Clinical Medicine
    Weill Cornell Medical College
    Brooklyn, New York

    No relevant conflicts of interest to disclose.

    Evelyn Brosnan, MD, MBA
    Chief Hematology/Oncology Fellow
    University of North Carolina
    Chapel Hill, North Carolina

    No relevant conflicts of interest to disclose.

    Lowell Hart, MD
    Scientific Director of Research
    Florida Cancer Specialists
    Associate Professor of Medicine
    Wake Forest Baptist Health
    Fort Myers, Florida

    Speakers Bureau: Boehringer Ingelheim Pharmaceuticals Inc, Lilly, Pfizer Inc.

    Namrata Peswani, MD
    Advocate Health Care
    Orland Park, Illinois

    No relevant conflicts of interest to disclose.

    MODERATOR — 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, Loxo Oncology, 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 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 AstraZeneca Pharmaceuticals LP, Genentech, Genomic Health Inc, Lilly, Merck, Puma Biotechnology Inc and Seattle Genetics.

    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: January 2019
    Expiration date: January 2020

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Watch videos
(WIFI is recommended for best performance):


Neoadjuvant, Adjuvant and Extended-Adjuvant Therapy for Patients with Localized HER2-Positive Breast Cancer (BC)

Use of Genomic Classifiers to Assist in Clinical Decision-Making for Patients with ER-Positive Early BC

Selection and Sequence of Therapy for Patients with ER-Positive, HER2-Negative Metastatic BC (mBC); Ongoing Trials of CDK4/6 Inhibitors for Localized ER-Positive Disease

Management of Metastatic Triple-Negative BC; Available Research Data with and Ongoing Evaluation of Immune Checkpoint Inhibition in BC

Long-Term Management of HER2-Positive mBC; Treatment of HER2-Positive Brain Metastases; Novel Agents

PARP Inhibitors; Novel Targeted Agents and Other Emerging Therapeutic Strategies

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