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Cases from the Community: Investigators Provide Their Perspectives on the Practice Implications of Emerging Clinical Research — A Special Video Supplement
Released June 2017

A special video supplement to a CME meeting held during the 2016 San Antonio Breast Cancer Symposium featuring expert comments on the application of emerging research to patient care. Featuring perspectives from Drs Joyce O’Shaughnessy and Ian E Smith. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists, breast cancer surgeons, radiation oncologists and other healthcare professionals involved in the diagnosis and treatment of breast cancer (BC).

    The current clinical management of BC is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease (micro- or macroscopic) with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indication and/or utility of these local and systemic treatment options is largely based on a number of prognostic and predictive risk factors present within the patient or her tumor at the time of diagnosis. Increasingly, an emphasis is being placed on a “personalized medicine” approach that promises to more effectively identify treatments that will benefit individuals based on specific patient- and disease-related characteristics. The pace of change in the field of breast medical oncology has been rapid, creating an important need for education about the unique mechanisms of action, toxicities and effectiveness of novel agents to properly prepare clinicians for their appropriate use (or potential use) in clinical practice. Several consensus- and evidence-based treatment guidelines are available and aim to assist clinicians with making BC management decisions in the face of this dynamic clinical and research environment, but despite the existence of these tools many areas of controversy persist within academic and community settings.

    These highlights from postevent interviews with 2 faculty from a CME meeting held during the San Antonio Breast Cancer Symposium explore the most significant therapeutic advances during the previous year by using the perspectives of these BC experts on challenging cases and questions submitted by clinicians in the community to frame a relevant discussion of how this information has aided in the refinement of current routine clinical practice and ongoing research. This CME activity will help medical oncologists find answers to the individualized questions and concerns that they frequently encounter and in turn provide high-quality cancer care.


    • Consider available data and the use of biomarkers and genomic assays to assess risk and individualize therapy for patients with hormone receptor-positive BC in the neoadjuvant and adjuvant settings.
    • Individualize the selection of evidence-based neoadjuvant and adjuvant chemobiologic regimens for patients with HER2-overexpressing early BC.
    • Implement a long-term clinical plan for the management of metastatic HER2-positive BC, incorporating existing and investigational targeted treatments.
    • Develop an understanding of the available research data and ongoing trials of investigational CDK4/6 inhibitors and other novel therapies under development for the management of advanced ER-positive BC.
    • Recall the scientific rationale and efficacy data with PARP inhibitors for patients with BRCA-mutant BC, and employ this information in the formulation of protocol and nonprotocol treatment recommendations for these individuals.

    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:

    Joyce O’Shaughnessy, MD
    Chair, Breast Cancer Research Program
    Baylor Charles A Sammons Cancer Center
    Texas Oncology
    US Oncology
    Dallas, Texas

    Consulting Agreements: AstraZeneca Pharmaceuticals LP, Celgene Corporation, Eisai Inc, Genentech BioOncology, Lilly, Novartis Pharmaceuticals Corporation, Pfizer Inc, Roche Laboratories Inc, Sanofi Genzyme, Takeda Oncology.

    Ian E Smith, MD
    Professor of Cancer Medicine
    The Royal Marsden Foundation Trust and Institute of Cancer Research
    London and Surrey
    United Kingdom

    Advisory Committee: Eisai Inc, Pierre Fabre, Seattle Genetics.

    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, Adaptive Biotechnologies, 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, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals 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 AbbVie Inc, Agendia Inc, Astellas Pharma Global Development Inc/Medivation Inc, a Pfizer Company, AstraZeneca Pharmaceuticals LP, bioTheranostics Inc, Celgene Corporation, Genentech BioOncology, Genomic Health Inc, Lilly and Tesaro Inc.

    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: June 2017
    Expiration date: June 2018

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(WIFI is recommended for best performance):

Adjuvant and neoadjuvant therapy for HER2-positive breast cancer (BC)

  • Essential factors to consider when contemplating the use of neoadjuvant therapy
  • Dosing and tolerability of pertuzumab
  • Case discussion: A 67-year-old man with ER-positive, HER2-positive, node-positive IDC who has difficulty tolerating adjuvant tamoxifen

Management of HER2-positive metastatic BC (mBC)

  • Case discussion: A 78-year-old woman with de novo ER/PR-positive, HER2-positive mBC
  • Duration of HER2-directed therapy
  • Case discussion: A 35-year old woman with ER/PR-negative, HER2-positive BC treated 2 years ago with adjuvant chemotherapy/trastuzumab presents with an isolated breast recurrence
  • Duration of trastuzumab/pertuzumab maintenance therapy
  • Choice of chemotherapeutic regimen for a patient not eligible for an anthracycline or a taxane
  • Roles of next-generation sequencing and liquid biopsy in mBC

Clinical decision-making for patients with ER-positive early BC

  • Case discussion: A 41-year-old woman with a 1.6-cm, ER-positive, HER2-negative IDC with a 1-cm biopsy-positive axillary node and Ki-67 of 50%
  • MINDACT trial: Utility of the 70-gene signature in selecting patients with BC for adjuvant chemotherapy
  • Use of genomic assays to predict benefit from extended endocrine therapy in ER-positive, HER2-negative BC
  • Case discussion: A 65-year-old woman with ER-positive, HER2-negative, node-positive BC receives neoadjuvant palbociclib/letrozole on a clinical trial
  • Role of neoadjuvant endocrine therapy and chemotherapy for premenopausal patients with ER-positive BC
  • Case discussion: A 58-year-old woman with ER/PR-positive, HER2-negative invasive lobular carcinoma

Management of ER-positive, HER2-negative mBC

  • Efficacy and tolerability of the CDK4/6 inhibitors palbociclib and ribociclib in ER/PR-positive, HER2-negative mBC
  • Case discussion: A 30-year-old woman with ER-positive, PR-negative, HER2-negative, node-positive BC and a biopsy-proven liver metastasis
  • Case discussion: A 51-year-old woman with strongly ER/PR-positive, HER2-negative BC and 12 of 12 positive nodes
  • Therapeutic options for patients with ER-positive BC and disease progression on palbociclib-based therapy
  • Use of capecitabine for aromatase inhibitor-refractory mBC

Indications for BRCA testing in BC and ongoing investigation of PARP inhibition

  • Use of PARP inhibitors in BRCA mutation-positive BC
  • Therapeutic options for a patient with high-risk ER-positive BC and a BRCA germline mutation
  • Importance of genetic testing

Treatment of triple-negative BC (TNBC)

  • Case discussion: A 60-year old woman with previously treated mTNBC presents with a painful sternal metastasis