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Assisting Community-Based Oncologists and Surgeons in Making Neoadjuvant Treatment Decisions for Patients with Early Breast Cancer
Released February 2016

Featuring perspectives from Drs Kimberly L Blackwell and Eleftherios P Mamounas. (Video Program)

CE Disclosures and Faculty Information

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

    Neoadjuvant systemic therapy is an important therapeutic option for patients with inoperable early breast cancer and those wishing to potentially undergo breast-conserving surgery. However, the potential benefits of preoperative therapy have led some to consider its adoption for a wider population of patients. The September 2013 approval of the first ever systemic agent (pertuzumab) for use as neoadjuvant therapy and several other recent advances related to the diagnosis and treatment of early breast cancer have sparked renewed interest in the role of this approach. Interestingly, little published information is available regarding the current integration of neoadjuvant therapy into standard treatment algorithms. Similarly, resources designed to assist clinicians in identifying patients for and guiding the use of preoperative therapy appear to be limited. Furthermore, it has been postulated that the level of collaboration between the multidisciplinary “players” involved in the diagnosis, care coordination and management of early breast cancer can vary dramatically based on the dynamics of the individual community or organization.

    The optimal integration of neoadjuvant systemic therapy and the overall management of early breast cancer are complex and challenging clinical issues for which a divergence of opinion and understanding may exist between the practicing oncologist and his or her general or breast surgeon colleague. This CME activity uses the perspectives of medical oncologist and breast cancer surgeon experts to not only provide increased insight into the current thinking behind and practice patterns of surgical and oncology clinical investigators with regard to neoadjuvant therapy but also create and develop an educational resource which will assist general medical oncologists and general/breast surgeons in making effective and informed management decisions.


    • Describe the self-reported practice patterns of medical oncologist and surgical experts with regard to the use of neoadjuvant systemic therapy, and use this information to identify patients who should be considered for this approach.
    • Appreciate the key clinical variables that affect the indication for and selection of preoperative therapy, and integrate this information into future treatment decision-making.
    • Recognize the FDA approval of pertuzumab in the neoadjuvant setting, and develop an evidence-based approach for its integration into clinical practice for patients with HER2-positive disease.
    • Consider the potential benefit of neoadjuvant systemic therapy for patients with operable breast cancer, and determine if the risk-benefit ratio supports its use outside of a protocol.
    • Articulate ongoing clinical trials examining the potential benefits of neoadjuvant systemic therapy, and refer appropriate patients for potential participation.

    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:

    Kimberly L Blackwell, MD
    Professor of Medicine
    Assistant Professor in Radiation Oncology
    Duke University Medical Center
    Durham, North Carolina

    Consulting Agreements: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc, Sandoz; Contracted Research: Celgene Corporation, Genentech BioOncology, Pfizer Inc.

    Eleftherios P Mamounas, MD, MPH
    Medical Director, Comprehensive Breast Program
    University of Florida Cancer Center at Orlando Health
    Professor of Surgery, University of Central Florida
    Clinical Professor of Clinical Sciences, Florida State University
    Orlando, Florida

    Advisory Committee and Consulting Agreements: Celgene Corporation, Eisai Inc, Genomic Health Inc, GlaxoSmithKline, Pfizer Inc; Speakers Bureau: Genentech BioOncology, Genomic Health Inc.

    MODERATORDr 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 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, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, ImmunoGen Inc, Incyte Corporation, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Teva Oncology, Tokai Pharmaceuticals Inc 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: February 2016
    Expiration date: February 2017

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Local disease control and neoadjuvant treatment
Neoadjuvant treatment and local disease control
Neoadjuvant treatment to facilitate breast-conserving surgery
Timing of sentinel node biopsy
Neoadjuvant treatment for patients with clinically positive nodes
Axillary node dissection in a patient with a positive sentinel node biopsy after neoadjuvant treatment
Clinical trials evaluating management of the axilla in patients receiving neoadjuvant treatment
Neoadjuvant treatment of HER2-positive tumors
Neoadjuvant treatment of HER2-positive tumors
Overview of pertuzumab
Response to chemotherapy/anti-HER2 treatment based on ER status
Tolerability/toxicity issues with pertuzumab
Clinical trials of neoadjuvant treatment in HER2-positive disease
FDA approval of pertuzumab as a component of neoadjuvant treatment
Neoadjuvant versus adjuvant treatment of HER2-positive tumors
Overview of T-DM1
NSABP trial B-52: Combining endocrine therapy with anti-HER2 treatment
ATEMPT adjuvant study in HER2-positive disease
Neoadjuvant treatment of triple-negative tumors
Key issues in neoadjuvant treatment for patients with triple-negative disease
Tumor size and the decision to use neoadjuvant treatment in patients with triple-negative disease and a negative axilla clinically
Advantages to neoadjuvant treatment in patients preferring mastectomy
Neoadjuvant treatment of ER-positive, HER2-negative tumors
Neoadjuvant treatment of ER-positive, HER2-negative tumors
NSABP trial of the 21-gene Recurrence Score in the neoadjuvant setting
Preoperative genomic assays in patients with ER-positive, HER2-negative tumors
ALTERNATE trial of neoadjuvant endocrine treatment
Other issues in neoadjuvant treatment
Pathologic complete response and long-term outcome
Axillary ultrasound in a patient with clinically negative axilla
Assessing tumor response during neoadjuvant treatment
MRI in patients receiving neoadjuvant treatment