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Consensus or Controversy, Issue 1: Clinical Investigators Provide Their Perspectives on Controversial Issues in the Management of Early Breast Cancer
Released January 2017

Clinical investigators provide concise comments on therapy for patients with early breast cancer. Featuring perspectives from Drs Sarat Chandarlaplaty, William J Gradishar, Kathy D Miller, Ruth M O’Regan, Lee S Schwartzberg, Melinda L Telli, Sarah M Tolaney, and Denise A Yardley.

CE Disclosures and Faculty Information

  • TARGET AUDIENCE
    This activity is intended for medical oncologists, oncology fellows, oncology nurses and other healthcare providers involved in the treatment of breast cancer.

    OVERVIEW OF ACTIVITY
    Breast cancer remains the most frequently diagnosed cancer in women, and in 2016 in the United States alone the disease culminated in an estimated 246,660 new cases and 40,890 deaths. The current clinical management of breast cancer is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indications for and utility of these local and systemic treatment options are largely based on a number of prognostic and predictive risk factors present in the patient or her tumor at the time of diagnosis. While the diagnosis and treatment of breast cancer is still in many ways more advanced than that of other solid cancers, challenging issues in the basic management of this disease continue to require refinement. Many areas of controversy persist within the academic and community settings despite several consensus- and evidence-based treatment guidelines that aim to assist clinicians in making breast cancer management decisions in a dynamic clinical and research environment. To provide clinicians with therapeutic strategies to address the disparate needs of patients with breast cancer, this program will present the perspectives of clinical investigators on key challenges and controversies to address the existing management uncertainties of clinician learners and help keep them up to date in a continuously evolving therapeutic landscape.

    LEARNING OBJECTIVES
    • Review faculty recommendations for the selection and use of evidence-based neoadjuvant treatment regimens for patients with early breast cancer, and consider this information when caring for such patients.
    • Compare and contrast faculty preferences on the use of genomic assays as tools to assist in neoadjuvant treatment decision-making.
    • Evaluate the importance of residual tumor size in faculty preferences for the administration of additional chemotherapy to patients with residual disease after neoadjuvant chemotherapy.
    • Assess approaches considered by the faculty for the management of the axilla —sentinel lymph node biopsy or axillary lymph node dissection — in patients with invasive breast cancer and axillary adenopathy who experience clinical responses to neoadjuvant chemotherapy.

    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
    Research To Practice designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) — MAINTENANCE OF CERTIFICATION (MOC)
    Successful completion of this CME activity enables the participant to earn up to 1.5 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Please note, this program has been specifically designed for the following ABIM specialty: medical oncology.

    Personal information and data sharing: Research To Practice aggregates deidentified user data for program-use analysis, program development, activity planning and site improvement. We may provide aggregate and deidentified data to third parties, including commercial supporters. We do not share or sell personally identifiable information to any unaffiliated third parties or commercial supporters. Please see our privacy policy at ResearchToPractice.com/Privacy-Policy for more information.

    HOW TO USE THIS CME ACTIVITY
    This CME activity consists of a text component. To receive credit, the participant should review the treatment preference matrix, complete the post-test with a score of 80% or better and fill out the Educational Assessment and Credit Form located on our website at ResearchToPractice.com/COCBC17/1/CME.

    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:

    Sarat Chandarlapaty, MD, PhD
    Medical Oncologist
    Memorial Sloan Kettering Cancer Center
    New York, New York

    Consulting Agreements: Agendia Inc, AstraZeneca Pharmaceuticals LP, Chugai Pharmaceutical Co Ltd, MacroGenics Inc, Sermonix Pharmaceuticals; Contracted Research: Lilly, Novartis Pharmaceuticals Corporation.

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

    No financial interests or affiliations to disclose.

    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: Astellas Pharma Global Development Inc, Genentech BioOncology, Medivation Inc, Merrimack Pharmaceuticals Inc, Novartis Pharmaceuticals Corporation, Pfizer Inc, Taiho Oncology Inc; Data Monitoring Committee: ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Merck.

    Ruth M O’Regan, MD
    Professor of Medicine
    Chief, Division of Hematology/Oncology
    University of Wisconsin Carbone Cancer Center
    Madison, Wisconsin

    Advisory Committee: bioTheranostics Inc, Lilly, Pfizer Inc; Contracted Research: Novartis Pharmaceuticals Corporation, Pfizer Inc.

    Lee S Schwartzberg, MD
    Medical Director, The West Clinic
    Clinical Professor of Medicine
    University of Tennessee School of Medicine
    Memphis, Tennessee

    Consulting Agreements: Amgen Inc, Bristol-Myers Squibb Company, Genomic Health Inc, Pfizer Inc, Spectrum Pharmaceuticals Inc; Speakers Bureau: Genentech BioOncology.

    Melinda L Telli, MD
    Assistant Professor of Medicine
    Stanford University School of Medicine
    Stanford, California

    Advisory Committee: Tesaro Inc, Vertex Pharmaceuticals Incorporated; Consulting Agreement: AstraZeneca Pharmaceuticals LP; Contracted Research: Abbott Laboratories, Calithera Biosciences, Genentech BioOncology, Medivation Inc, OncoSec Medical, PharmaMar, Vertex Pharmaceuticals Incorporated.

    Sarah M Tolaney, MD, MPH
    Department of Medical Oncology
    Dana-Farber Cancer Institute
    Assistant Professor in Medicine
    Harvard Medical School
    Boston, Massachusetts

    Contracted Research: Genentech BioOncology, Lilly, Merck, Novartis Pharmaceuticals Corporation, Pfizer Inc.

    Denise A Yardley, MD
    Senior Investigator, Breast Cancer Research
    Sarah Cannon Research Institute 
    Tennessee Oncology PLLC
    Nashville, Tennessee

    Advisory Committee: Novartis Pharmaceuticals Corporation; Speakers Bureau: Eisai Inc, Genentech BioOncology.

    EDITOR — 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, Acerta Pharma, Agendia 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, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Therapeutics, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, 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 LLC, an AbbVie Company, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, 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 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 Celgene Corporation, Genentech BioOncology, Genomic Health Inc, Lilly 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: January 2017
    Expiration date: January 2018

    After completing the Post-test, learners may download and review the answers here in order to identify further areas of study.

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