The sixth seminar of our eight-part online, integrated educational course explores topics relevant to the treatment of TNBC. Originally held on July 19, 2011, Part VI features Drs Harold J Burstein and Charles E Geyer Jr. (Webinar)
CE Disclosures and Faculty Information
TARGET AUDIENCE
This activity is intended for medical oncologists, hematology-oncology fellows and other healthcare providers involved in the treatment of breast cancer.
OVERVIEW OF ACTIVITY
TNBC represents a more aggressive, higher-risk phenotype with an increased incidence of distant recurrence and death compared to other types of breast cancer. Despite an overall increase in knowledge of the biologic and natural history of TNBC, inadequate effective therapies for this patient subset persist. To offer optimal patient care — including the option of clinical trial participation — practicing medical oncologists, hematology-oncology fellows and other healthcare providers must be well informed of these advances. This program uses a review of recent ASCO papers and other relevant publications, faculty case presentations, Q&A and discussion of community practice patterns to assist practicing clinicians with the incorporation of newly published data into best-practice breast cancer treatment algorithms.
LEARNING OBJECTIVES- Develop a therapeutic algorithm for the evidence-based management of TNBC.
- Counsel appropriately selected patients about availability of and participation in ongoing clinical research studies focusing on the management of early and advanced TNBC.
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
CME credit is no longer available for this issue
This CME activity consists of a video component. The participant should watch the video.
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:
Harold J Burstein, MD, PhD
Associate Professor of Medicine
Harvard Medical School
Breast Oncology Center
Dana-Farber Cancer Institute
Boston, Massachusetts
No real or apparent conflicts of interest to disclose.
Charles E Geyer Jr, MD
Director of Medical Affairs
National Surgical Adjuvant Breast and Bowel Project
Vice-Chair, Department of Human Oncology
Allegheny General Hospital
Pittsburgh, Pennsylvania
No real or apparent conflicts of interest to disclose.
MODERATOR — 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: Allos Therapeutics, Amgen Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Aureon Laboratories Inc, Bayer HealthCare Pharmaceuticals/Onyx Pharmaceuticals Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Cephalon Inc, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, EMD Serono Inc, Genentech BioOncology, Genomic Health Inc, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Lilly USA LLC, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Myriad Genetics Inc, Novartis Pharmaceuticals Corporation, OSI Oncology, Sanofi and Seattle Genetics.
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 Sanofi.
Hardware/Software Requirements:
An Internet connection that is at least 28.8 Kbps
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 6.x or newer, Firefox 2.x or newer, or Safari 2.x or newer
Macromedia Flash plug-in 6.0 or greater
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio
Last review date: July 2011
Expiration date: July 2012
Acknowledge and close
(WiFi is recommended for best performance):
1. Is TNBC a distinct biologic entity?
Although both faculty members answer affirmatively, it is interesting that the related so-called basal intrinsic subtype includes approximately 20 percent with ER positivity, HER2 positivity or both. In addition, as discussed on a prior webcast in this series with Joyce O’Shaughnessy and Eric Winer, patients identified as having TNBC may in fact have disease that falls into any of the intrinsic subtypes (although mostly basal). Hope Rugo’s ASCO discussion highlighted another important point that further clouds these waters, namely the not-uncommon errors that occur in ER and HER2 testing.
2. Are bevacizumab and platinum agents more effective in patients with TNBC than in those with ER-positive, HER2-negative disease?
Neither Dr Burstein nor Dr Geyer could fully explain the two related ASCO neoadjuvant presentations. The first from the NSABP demonstrated more pathologic complete responses when bev was added to chemo, mainly in patients with ER-positive (HER2-negative) tumors. This was in contrast to findings from the ever-productive German group, who updated their San Antonio data at ASCO, showing that the major benefit of adding bev to neoadjuvant chemo was in TNBC. At a more global level, Chuck reaffirmed that chemo is generally more effective in TNBC but the natural history is also more aggressive. In terms of platinums, the faculty was split with Hal quite unimpressed with the activity reported but Chuck inclined to include a platinum agent early in his metastatic TNBC sequence, particularly in patients with BRCA mutations.
3. Do PARP inhibitors have activity in TNBC?
Hal presented a patient from his practice with a deleterious BRCA2 mutation and extensive, symptomatic and rapidly progressive metastatic TNBC who participated in a trial of olaparib monotherapy. In his review of a series of CAT scans it was clear that the patient experienced an impressive PR that resulted in excellent palliation for 15 months. Although limited data have emerged on olaparib outside of the BRCA setting, the responses that have been observed in patients with BRCA mutations, such as this woman, are reason for cautious optimism. In terms of the much-discussed and very disappointing ASCO data with iniparib, both faculty believe it’s “time to go back to the drawing board” and figure out how the agent works and whether it has a role in oncology.
4. Beta-blockers?
A few days before this live broadcast, our scientific team unearthed two fascinating and just electronically published JCO papers from Ireland and MD Anderson and an accompanying editorial by Chuck’s NSABP colleague Patricia Ganz. Both articles and Dr Ganz’s commentary support prior studies suggesting that patients taking beta-blockers (BBs) have a more favorable breast cancer natural history. Specifically, the MD Anderson study showed that patients receiving BBs had better outcomes with neoadjuvant chemo compared to those not taking these medications. Why this is the case is unclear, but Dr Ganz and others have speculated that a yet-unknown effect on the tumor microenvironment may be at play. The new NSABP-B-47 adjuvant trial (trastuzumab in HER2 1+ and 2+ disease) is prospectively gathering data on lifestyle, comorbidities and noncancer medications in search of more clues on host-related factors affecting cancer progression.
Neil Love, MD
Research To Practice
Miami, Florida