TARGET AUDIENCE
This activity is intended for medical oncologists, hematologist-oncologists and other healthcare providers involved in the treatment of breast cancer.

OVERVIEW OF ACTIVITY
Individualized treatment decisions for patients with metastatic breast cancer (mBC) are driven by disease and patient characteristics. ER-positive disease, which represents approximately 63% of all cases, is perhaps the most nuanced subtype in regard to therapeutic decision-making in the advanced setting. 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. This important distinction has historically added complexity to the care of these patients as clinicians are consistently forced to evaluate the risk-benefit ratios of the many available options and give significant consideration to the preferences of patients when making therapeutic recommendations. While this and several other factors have defined the management of ER-positive mBC, several groundbreaking advances now add even greater challenges to this prevalent clinical situation.

To provide clinicians with therapeutic strategies to address the disparate needs of patients with ER-positive mBC, the Visiting Professors series employs an innovative case-based approach that unites the perspectives of leading breast cancer investigators and general oncologists as they explore the intricacies of treatment decisions. Upon completion of this CME activity, medical oncologists should be able to formulate an up-to-date and more complete approach to the care of these patients.

LEARNING OBJECTIVES

• Implement a clinical plan for the management of ER-positive mBC, considering the patient’s clinical presentation, prior treatment course and psychosocial status.
• Assess the FDA indications for the commercially available CDK4/6 inhibitors, and discern how these agents can be optimally employed in the management of ER-positive mBC.
• Educate patients regarding the unique side effects associated with approved and investigational CDK4/6 inhibitors, and develop preventive and emergent strategies to reduce or ameliorate these toxicities.
• Appraise 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 metastatic disease.
• Consider the mechanisms of action, available research data and potential clinical benefits of other novel therapies under development, and counsel patients with advanced ER-positive breast cancer regarding ongoing research opportunities.

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
CME credit is no longer available for this issue

AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) — MAINTENANCE OF CERTIFICATION (MOC)
CME credit is no longer available for this issue

HOW TO USE THESE CME ACTIVITIES
Audio Program: This CME activity consists of an audio component.
CME credit is no longer available for this issue

Video Program: This CME activity consists of a video component.
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 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:

Clinical Investigators

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 BioOncology, Lilly, Merck, Nektar, Novartis, Pfizer Inc.

Kathy D Miller, MD
Co-Director, IU Simon Cancer Center Breast Cancer Program
Ballvé-Lantero Scholar in Oncology
Professor of Medicine, Division of Hematology/Oncology
The Indiana University Melvin and Bren Simon Cancer Center
Indianapolis, Indiana

Contracted Research: AbbVie Inc, Astellas Pharma Global Development Inc, Medivation Inc, a Pfizer Company, Merrimack Pharmaceuticals Inc, Novartis, Pfizer Inc.

Consulting Oncologists

Sulfi Ibrahim, MD
Hematology Oncology of Indiana
Indianapolis, Indiana

No relevant conflicts of interest to disclose.

Laila Agrawal, MD
Norton Healthcare
Louisville, Kentucky

No relevant conflicts of interest to disclose.

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, 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, 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, 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, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pfizer Inc, 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 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 Lilly and Novartis.

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: May 2018
Expiration date: May 2019