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Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC, 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.


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Cancer Summaries and Commentaries™: Update from Chicago: Advances in the Treatment of Breast Cancer - PER Pulse™ Recaps
PER Pulse Recap

PER Pulse™ Recap


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PER Pulse™ Recap:

Cancer Summaries and Commentaries™: Update from Chicago: Advances in the Treatment and Management of Breast Cancer


Cancer Summaries and Commentaries™: Update from Chicago: Advances in the Treatment and Management of Breast Cancer is an online CME publication designed to update physicians on key clinical data and highlights in breast cancer presented at a major 2016 Oncology Annual Meeting held in Chicago. This is accompanied by audio commentaries from Drs. Pamela Munster and Ruth O’Regan, who offer their perspectives on the data and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This first of 2 PER Pulse™ Recaps summarizing the program focuses on results from the phase III PALOMA-2 trial, an ongoing study evaluating the efficacy of adding the CDK4/6 inhibitor palbociclib to letrozole as first-line therapy for postmenopausal women with estrogen receptor (ER)‒positive, HER2-negative, advanced breast cancer. At 23.0 months of follow-up, the primary endpoint of progression-free survival (PFS) was prolonged by approximately 12 months in the palbociclib-containing arm versus the placebo arm (N = 666; median PFS: 24.8 mo with palbociclib vs 14.5 mo with placebo; hazard ratio, 0.58; 95% CI, 0.46-0.72; P <.000001). The survival benefits of palbociclib were observed across all subgroups. Nonfebrile neutropenia was experienced by two-thirds of patients in this trial.

Commentaries include the following:
  • Dr. Munster discusses the integral role that CDK4/6 inhibitors are assuming in ER‒positive, advanced breast cancer.
  • Dr. O’Regan notes that these results were in agreement with those of the phase II PALOMA-1 study, and that they were confirmed at both investigator and central review level. She does not view these results as practice-changing because many physicians are already using palbociclib in this setting. Nonetheless, she believes that the increased strength of evidence supporting first-line use of palbociclib is important.
  • Dr. O’Regan reviews recommendations for monitoring and managing neutropenia with palbociclib, and shares her perspectives on best practices.
  • Dr. Munster recommends discussing the possibility of hair loss with patients who will receive palbociclib, noting that 33% of patients who received this agent in the PALOMA-2 study experienced grade 1-2 alopecia.


PER Pulse™ Recap


2 of 2
PER Pulse™ Recap:


PER Pulse™ Recap:
Cancer Summaries and Commentaries™: Update from Chicago: Advances in the Treatment and Management of Breast Cancer


Cancer Summaries and Commentaries™: Update from Chicago: Advances in the Treatment and Management of Breast Cancer is an online CME publication designed to update physicians on key clinical data and highlights in breast cancer presented at a major 2016 Oncology Annual Meeting held in Chicago. This is accompanied by audio commentary from Drs. Pamela Munster and Ruth O’Regan, who offer their perspectives on the data and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This second of 2 PER Pulse™ Recaps summarizing the program focuses on results from the phase III MA.17R trial, evaluating disease-free survival (DFS) benefits of extending letrozole therapy for 5 years after standard 5-year aromatase inhibitor (AI) therapy for postmenopausal women with early-stage, hormone receptor‒positive breast cancer.

Patients in the ongoing MA.17R trial were randomized to receive 5 years of letrozole 2.5 mg orally once daily or placebo after standard 5-year AI therapy with or without tamoxifen. The trial consists of 3 patient cohorts: cohort 1 includes patients who received letrozole in the precursor MA.17 trial; cohort 2 includes patients who were not in the MA.17 study, but who had completed 5 years of AI therapy after tamoxifen; and cohort 3 includes patients who had received 5 years of AI therapy without any prior tamoxifen. At a mean follow-up of 6.3 years, fewer recurrences were observed in the letrozole arm versus the placebo arm (5-year DFS: 95% with letrozole vs 91% with placebo; HR, 0.66; P =.01). These benefits were observed across all prespecified subgroups. Toxicities were uncommon; however, more bone fractures and cases of new-onset osteoporosis were reported in the letrozole arm versus the placebo arm.

Commentaries include the following:
  • Dr. O’Regan discusses the 50% decrease in the incidence of contralateral breast cancer observed among patients who received extended letrozole therapy, as well as uncertainties regarding the significance of this benefit versus the increased bone toxicity reported.
  • Dr. O’Regan does not view these data as practice-changing because AI therapy is commonly extended beyond 5 years for high-risk patients. She noted, however, that the data do provide some support to extending letrozole therapy for patients who received tamoxifen followed by 5 years of AI therapy.
  • Dr. Munster recommends discussing with patients who have difficulty with AI therapy due to side effects that no improvement in overall survival was observed with extended AI therapy.





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