TARGET AUDIENCE
This activity is intended for medical oncologists, hematology-oncology fellows and other allied healthcare professionals involved in the treatment of breast cancer.
OVERVIEW OF ACTIVITY
Breast cancer remains the most frequently diagnosed cancer in women, and in 2014 in the United States alone it is estimated the disease will culminate in 232,670 new cases and 40,000 deaths. Patients with HER2-positive disease account for 15% to 20% of all breast cancer cases, or approximately 35,000 to 46,000 new patients per year. In 1987 amplification of the HER2 oncogene was determined to result in reduced survival in breast cancer, which triggered the development of trastuzumab as the first targeted therapy based on a molecular cancer abnormality. Over the ensuing quarter century significant advances have been made in the understanding of the biology and the clinical management of HER2-positive breast cancer.
However, considerable gaps remain in optimizing treatment of this disease subtype, particularly with the growing armamentarium of effective HER2-targeted agents. In the treatment of early-stage HER2-positive breast cancer several issues remain incompletely elucidated, including who should receive neoadjuvant versus adjuvant therapy, the use of single versus dual anti-HER2 blockade, the use of anthracycline- versus nonanthracyline-containing chemotherapy and the approach to therapy for patients with small, node-negative disease. In the advanced disease setting several clinical questions remain open, including the optimal sequencing of treatments in the first, second and later lines of treatment, the timing and duration of treatment, how previous adjuvant HER2-targeted therapy influences treatment decision-making, how hormone receptor status can affect therapeutic options and how best to manage brain metastases, which occur in approximately 50% of patients with metastatic HER2-positive disease. In addition to the preceding issues, HER2 test results are discordant between primary and metastatic disease for 5% to 10% of patients, necessitating management approaches that may have a significant impact on treatment.
By providing access to the latest research developments and expert perspectives on the treatment of HER2-positive breast cancer in the neoadjuvant, adjuvant and metastatic settings, these proceedings from a case-based CME symposium held at the 2014 ASCO Annual Meeting aim to assist medical oncologists, breast surgeons and other healthcare providers as they attempt to formulate optimal disease management strategies in the face of a constantly evolving body of knowledge.
LEARNING OBJECTIVES
- Compare and contrast expert perspectives on HER2-positive breast cancer treatment recommendations, and use this information to refine or validate existing management strategies.
- Individualize the selection of evidence-based neoadjuvant and adjuvant systemic regimens for patients with HER2-overexpressing early breast cancer.
- Implement a clinical plan for the management of advanced HER2-positive breast cancer, incorporating existing and emerging targeted treatments.
- Develop an evidence-based algorithm for the treatment of advanced hormone receptor-positive, HER2-positive premenopausal and postmenopausal breast cancer, including the use of endocrine, biologic and chemotherapeutic agents.
- Communicate the availability of ongoing clinical trials evaluating novel anti-HER2 strategies, and counsel appropriately selected patients about study participation.
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
This CME activity consists of a video component. To receive credit, the participant should watch the video.
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 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.
Edith A Perez, MD
Deputy Director at Large
Mayo Clinic Cancer Center
Group Vice Chair
Alliance of Clinical Trials in Oncology
Serene M and Frances C Durling Professor of Medicine
Mayo Clinic
Jacksonville, Florida
No real or apparent conflicts of interest to disclose.
Kimberly L Blackwell, MD
Professor of Medicine
Director, Breast Cancer Program
Duke Cancer Institute
Durham, North Carolina
Advisory Committee: Amgen Inc, Roche Laboratories Inc; Consulting Agreements: Boehringer Ingelheim Pharmaceuticals Inc, Genentech BioOncology, Novartis Pharmaceuticals Corporation; Contracted Research: Celgene Corporation, Genentech BioOncology; Speakers Bureau: Genomic Health Inc.
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
Consulting Agreements: Celgene Corporation, Cepheid, Genentech BioOncology, Shionogi Inc.
Fabrice André, MD, PhD
Professor, Department of Medical Oncology
Institut Gustave Roussy
Villejuif, France
Advisory Committee: Astellas, AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals Corporation; Contracted Research: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals Corporation, Pfizer Inc; Speakers Bureau: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals Corporation.
CONSULTING ONCOLOGISTS — The following consulting oncologists (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:
Patricia A DeFusco, MD
Clinical Assistant Professor of Medicine
University of Connecticut School of Medicine
Director, Hartford Hospital Breast Program
Physician Leader
Hartford Healthcare Cancer Institute
Breast Disease Management Team
Hartford, Connecticut
Contracted Research: Genentech BioOncology, Genomic Health Inc, Roche Laboratories Inc.
Leon H Dragon, MD
Kellogg Cancer Center
Highland Park, Illinois
NorthShore University HealthSystem
Senior Clinician Educator
University of Chicago
Pritzker School of Medicine
Chicago, Illinois
No real or apparent conflicts of interest to disclose.
Bonni L Guerin, MD
Director of Breast Cancer Treatment and Prevention
Overlook Medical Center
Summit, New Jersey
Speakers Bureau: Celgene Corporation, Genomic Health Inc.
Carolyn B Hendricks, MD
The Center for Breast Health
Bethesda, Maryland
No real or apparent conflicts of interest to disclose.
Kert D Sabbath, MD
Smilow Cancer Hospital
Harold Leever Regional Cancer Center
Waterbury, Connecticut
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: AbbVie Inc, Amgen 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, Exelixis Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals Inc, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc, Teva Oncology and VisionGate Inc.
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
Last review date: September 2014
Expiration date: September 2015