RTP Mobile Logo
Second Opinion: Clinical Investigators Provide Their Perspectives on Challenging Cases and Controversies in the Management of Metastatic Breast Cancer
Released December 2013

Featuring perspectives from Dr Hope S Rugo. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists and other healthcare providers involved in the treatment of breast cancer.

    Breast cancer (BC) remains the most frequently diagnosed cancer in women, and it is estimated that approximately 234,580 new cases will be identified in the United States in the year 2013 and 40,030 individuals will die from the disease. Advances in screening and prevention have resulted in a steady down-stage migration at the time of disease presentation, such that only 5% of women have identifiable distant metastases at primary diagnosis. Because of this, the number of individuals living with BC has increased substantially, as has the population “at risk” for metastatic or recurrent disease. Depending on the histological subtype, the initial stage of their disease at the time of diagnosis and the subsequent treatment strategy employed, approximately 20% to 80% of these women will develop a distant metastasis within 5 years of their BC diagnosis.

    Historically, available treatment options offered little for patients with this incurable disease. However, with the introduction of more effective systemic therapies over the past 20 years, there has been a substantial improvement in clinical outcomes. While the diagnosis and treatment of this disease remains in many ways more advanced than for other solid cancers, challenging issues in the management of metastatic BC (mBC) continue to require refinement. Increasing emphasis is being placed on a “personalized medicine” approach that promises to more effectively identify specific treatments that will benefit the individual, based on specific patient and disease characteristics. In conjunction with this approach researchers are developing novel agents to target additional signaling pathways, with the aim of enhancing the efficacy of existing treatments or overcoming resistance/restoring sensitivity to endocrine therapy, chemotherapy or other biologics.

    To assist medical oncologists and other allied BC professionals in keeping informed about these approved and developmental approaches, these proceedings from a case-based CME Grand Rounds presentation introduce the perspectives of 12 renowned investigators on a number of controversial clinical and research issues in the management of mBC.


    • Compare and contrast expert perspectives on breast cancer treatment recommendations, and use this information to refine or validate your existing management strategies.
    • Implement a clinical plan for the management of advanced HER2-positive breast cancer, incorporating existing and recently approved targeted treatments.
    • Assimilate new clinical trial evidence into the therapeutic algorithm for advanced ER-positive postmenopausal breast cancer.
    • Integrate recent clinical trial results into the management of metastatic breast cancer with no evidence of disease.
    • Recall the results of pivotal trials introducing effective new breast cancer therapeutics, and identify their impact on existing treatment algorithms.
    • Counsel appropriately selected patients with breast cancer about participation in ongoing clinical trials investigating novel therapeutic agents and strategies.

    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. The participant should watch the video.

    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 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:

    Kimberly L Blackwell, MD
    Professor of Medicine
    Director, Breast Cancer Program
    Duke Cancer Institute
    Durham, North Carolina

    Advisory Committee: Novartis Pharmaceuticals Corporation; Consulting Agreements: Novartis Pharmaceuticals Corporation, Sandoz; Contracted Research: Celgene Corporation, Genentech BioOncology, Roche Laboratories Inc; Speakers Bureau: Genomic Health Inc.

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

    Advisory Committee: Roche Laboratories Inc; Consulting Agreements: Celgene Corporation, Genentech BioOncology, Genomic Health Inc, Novartis Pharmaceuticals Corporation; Speakers Bureau: Celgene Corporation, Genentech BioOncology, Novartis Pharmaceuticals Corporation.

    Lisa A Carey, MD
    Richardson and Marilyn Jacobs Preyer
    Distinguished Professor for Breast Cancer Research
    Chief, Division of Hematology and Oncology
    Physician-in-Chief, North Carolina Cancer Hospital
    Associate Director for Clinical Research
    Lineberger Comprehensive Cancer Center
    Chapel Hill, North Carolina

    Advisory Committee, Consulting Agreements and Speakers Bureau: Amgen Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi; Research Support: Genentech BioOncology, GlaxoSmithKline, Sanofi.

    William J Gradishar, MD
    Betsy Bramsen Professor of Breast Oncology
    Professor of Medicine
    Director, Maggie Daley Center
    for Women’s Cancer Care
    Robert H Lurie Comprehensive Cancer Center
    Northwestern University Feinberg School of Medicine
    Chicago, Illinois

    No real or apparent conflicts of interest to disclose.

    Julie R Gralow, MD
    Professor, Medical Oncology
    Jill Bennett Endowed Professorship in Breast Cancer
    University of Washington School of Medicine
    Director, Breast Medical Oncology
    University of Washington School of
    Medicine/Seattle Cancer Care Alliance
    Member, Clinical Research Division
    Fred Hutchinson Cancer Research Center
    Seattle, Washington

    Contracted Research: Amgen Inc, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc.

    Sara A Hurvitz, MD
    Assistant Clinical Professor of Medicine
    University of California, Los Angeles
    Director, Breast Oncology Program
    Medical Director, Clinical Research Unit
    Jonsson Comprehensive Cancer Center
    Los Angeles, California

    Contracted Research: Boehringer Ingelheim Pharmaceuticals Inc, Eisai Inc, Genentech BioOncology, GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Roche Laboratories Inc, Sanofi; Paid Travel: Novartis Pharmaceuticals Corporation.

    Ian E Krop, MD, PhD
    Associate Physician, Dana-Farber Cancer Institute
    Assistant Professor of Medicine
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee: Seattle Genetics; Clinical Trial Support: Genentech BioOncology.

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

    Consulting Agreements: Antigen Express, Nektar; Contracted Research: Genentech BioOncology, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company; Paid Research: Antigen Express, Clovis Oncology, EntreMed Inc, Merrimack Pharmaceuticals, Syndax Pharmaceuticals Inc, Taiho Pharmaceutical Co Ltd.

    Hyman B Muss, MD
    Professor of Medicine
    University of North Carolina
    Director of Geriatric Oncology
    Lineberger Comprehensive Cancer Center
    Chapel Hill, North Carolina

    Consulting Agreements: Pfizer Inc, Sanofi.

    Joyce O'Shaughnessy, MD
    Co-Director, Breast Cancer Research Program
    Baylor-Charles A Sammons Cancer Center
    Texas Oncology
    US Oncology
    Dallas, Texas

    Advisory Committee: Genentech BioOncology; Consulting Agreements: Arno Therapeutics Inc, Eisai Inc, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Roche Laboratories Inc, Sanofi.

    Mark D Pegram, MD
    Susy Yuan-Huey Hung Professor of Medicine
    Director of the Breast Oncology Program
    Director, Molecular Therapeutics Program
    Stanford Cancer Institute
    Stanford University School of Medicine
    Stanford, California

    Advisory Committee: Celgene Corporation, Genentech BioOncology; Consultant (Spouse): DAVA Oncology; Consulting Agreement: Genentech BioOncology; Contracted Research: Genentech BioOncology; Expert Testimony: Novartis Pharmaceuticals Corporation.

    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: Agensys Inc, a subsidiary of Astellas Pharma US, Amgen Inc, Eisai Inc, Genentech BioOncology, GlaxoSmithKline, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, MacroGenics Inc, Merck, Novartis Pharmaceuticals Corporation, Plexxikon Inc; Speakers Bureau: Genomic Health Inc.


    Mary Ann K Allison, MD
    Comprehensive Cancer Centers of Nevada
    Stephanie Campus
    Henderson, Nevada

    No real or apparent conflicts of interest to disclose.

    Alan B Astrow, MD
    Director, Division of Medical Oncology/Hematology
    Maimonides Cancer Center
    Brooklyn, New York

    No real or apparent conflicts of interest to disclose.

    Patricia A DeFusco, MD
    Senior Staff, Department of Medicine
    Hartford Hospital
    Assistant Clinical Professor in the Department of Medicine
    University of Connecticut School of Medicine
    Hartford, Connecticut

    No real or apparent conflicts of interest to disclose.

    EDITORDr 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: AbbVie Inc, Algeta US, Allos Therapeutics, Amgen Inc, ArQule Inc, Astellas, AstraZeneca Pharmaceuticals LP, 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, Exelixis Inc, Foundation Medicine Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Novartis Pharmaceuticals Corporation, Novocure, 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 grantors.

    This activity is supported by educational grants from Genentech BioOncology and Novartis Pharmaceuticals Corporation.

    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

    Last review date: December 2013
    Expiration date: December 2014

Acknowledge and close

Watch video
(WIFI is recommended for best performance):

A case-based Grand Rounds presentation featuring perspectives from Dr Hope S Rugo.
67:58 minutes.