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Accreditation/ Credit Designation

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

This activity is not approved for AMA PRA Category 1 Credit

Acknowledgment of Commercial Support

This activity is supported by educational grants from AstraZeneca, Celgene Corporation, Eisai, Genentech, Genomic Health, Inc., Lilly, Merck & Co., Inc., Nektar Therapeutics, Novartis Pharmaceuticals Corporation, and Puma Biotechnology, Inc.

For further information concerning Lilly grant funding, visit www.lillygrantoffice.com.

Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer® - PER Pulse™ Recap
PER Pulse™ Recap

Resources

Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer®
Earn up to 2.0 AMA PRA Category 1 Credits™
Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer® is a series of short video interviews with leading experts in the treatment of breast cancer, who address a variety of questions commonly faced by practicing community oncologists.

PER Pulse™ Recap
PER Pulse™ Recaps for Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer® focuses on areas of clinical challenge faced by practicing oncologists. A brief overview of trial data, along with expert perspective, are provided in these summaries.



PER Pulse™ Recap PER Pulse™ Recap
Medical Writer: Kim Farina, PhD


1 of 3
PER Pulse™ Recap

Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer® is a series of short video interviews with faculty from the14th Annual International Congress on the Future of Breast Cancer® who address a variety of questions commonly faced by practicing community oncologists. The activity features discussion by Rita Nanda, MD, on checkpoint inhibitors in triple-negative breast cancer (TNBC); Joyce O’Shaughnessy, MD, on emerging strategies for TNBC; and Sara Tolaney, MD, MPH, on early-stage, HER2-positive (HER2+) breast cancer. Throughout the activity, these physicians provide insights into how new data fit into the current field and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This first of 3 PER Pulse™ Recaps summarizing the program focuses on Dr. O’Shaughnessy discussing platinum agent use in neoadjuvant/adjuvant regimens for TNBC.

The use of platinum agents in neoadjuvant/adjuvant regimens for early-stage or locally advanced TNBC is not a standard of care; whether this approach provides a survival benefit is unknown. The current National Comprehensive Cancer Network (NCCN) Breast Cancer Practice Guidelines prefer dose-dense doxorubicin-cyclophosphamide followed by paclitaxel (q week or q2 weeks) or docetaxel plus cyclophosphamide for HER2-negative disease. In the randomized, phase II GeparSixto (stage II-III TNBC or HER2+ breast cancer) and CALGB/Alliance 40603 (stage II-III TNBC) trials, adding carboplatin to neoadjuvant chemotherapy improved pathologic complete response (pCR) rates (GeparSixto: paclitaxel, liposomal doxorubicin, bevacizumab; CALGB 40603: paclitaxel, doxorubicin, cyclophosphamide + carboplatin, bevacizumab, or carboplatin-bevacizumab). The improvement in pCR rates was greater among the subset of patients with TNBC (n = 84) in the GeparSixto trial compared with 58 patients without TNBC (53.2% [95% CI, 54.4-60.9] vs 36.9% [95% CI, 29.4-44.5, respectively]; P =.005).

  • Dr. O’Shaughnessy noted that a nonstandard chemotherapy backbone (paclitaxel, liposomal doxorubicin, bevacizumab) was used in the GeparSixto trial. The incremental benefit of adding carboplatin may differ in the context of a traditional neoadjuvant chemotherapy backbone.
  • In her own practice, based on results of the GeparSixto trial, Dr. O’Shaughnessy would consider carboplatin for a patient with high-risk TNBC and who has a family history of breast cancer or a germline mutation.
  • Dr. O’Shaughnessy reviewed important phase III group trials that have been initiated to further explore the use of adjuvant platinum agents in TNBC (eg, NRG-BR003, ECOG-ACRIN 1131).

2 of 3
PER Pulse™ Recap

Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer® is a series of short video interviews with faculty from the 14th Annual International Congress on the Future of Breast Cancer® who address a variety of questions commonly faced by practicing community oncologists. The activity features discussion by Rita Nanda, MD, on checkpoint inhibitors in triple-negative breast cancer (TNBC); Joyce O’Shaughnessy, MD, on emerging strategies for TNBC; and Sara Tolaney, MD, MPH, on early-stage, HER2-positive (HER2+) breast cancer. Throughout the activity, these physicians provide insights into how new data fit into the current field and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This second of 3 PER Pulse™ Recaps summarizing the program focuses on Dr. Nanda discussing applications of immune checkpoint inhibition in breast cancer that are being investigated in clinical trials.

Approximately 20% overall response rates (ORRs) were observed in 2 multicenter, phase I clinical trials of immune checkpoint inhibitors in programmed death-ligand 1 (PD-L1)-positive, advanced TNBC. Results from these studies were first reported at the 2014 San Antonio Breast Cancer Symposium. In the KEYNOTE-012 study (N = 32), the anti- programmed cell death protein 1 antibody pembrolizumab yielded an 18.5% ORR. Similarly, in a multicenter study of the anti-PD-L1 antibody atezolizumab (N = 12), a 19% ORR was reported. The median duration of response had not yet been reached in either study at the time results were reported.

  • Dr. Nanda commented that in comparison to results seen in studies of checkpoint inhibitors for other solid tumors, the results in TNBC were modest but durable, and comparable to those observed in studies of lung and urothelial cancer.
  • She also noted that a 20% ORR is remarkable for this heavily pretreated population, and that the durability of the responses seen in these studies is rare for such an aggressive form of breast cancer.
  • Dr. Nanda discussed adverse-event management and response kinetics in these studies, as well as ongoing clinical trials and the application of molecular markers toward patient selection for immune checkpoint inhibition therapy. 
     

3 of 3
PER Pulse™ Recap

Community Practice Connections™: 14th Annual International Congress on the Future of Breast Cancer® a series of short video interviews with faculty from the 14th Annual International Congress on the Future of Breast Cancer® who address a variety of questions commonly faced by practicing community oncologists. The activity features discussion by Rita Nanda, MD, on checkpoint inhibitors in triple-negative breast cancer (TNBC); Joyce O’Shaughnessy, MD, on emerging strategies for TNBC; and Sara Tolaney, MD, MPH, on early-stage, HER2-positive (HER2+) breast cancer. Throughout the activity, these physicians provide insights into how new data fit into the current field and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This third of 3 PER Pulse™ Recaps summarizing the program focuses on Dr. Tolaney’s discussion of both standard and emerging strategies for early-stage, HER2+ breast cancer in the context of the latest clinical trial data.

  • Dr. Tolaney explained that long-term outcomes from studies of adjuvant pertuzumab for early-stage, HER2+ breast cancer are not available. While the National Comprehensive Cancer Network (NCCN) Breast Cancer Guidelines prefer adjuvant pertuzumab for patients who did receive it preoperatively, it is hoped that results of the ongoing APHINITY trial will supply more definitive guidance on the optimal use of adjuvant pertuzumab.
  • Clinical questions have also surrounded use of trastuzumab for node-negative, early-stage, HER2+ breast cancer. This is due in part, as Dr. Tolaney discussed, to patients with these tumors being excluded from pivotal trials of trastuzumab. Based on results of the APT trial, published in 2015, the NCCN Breast Cancer Guidelines now include paclitaxel-trastuzumab as an option for low-risk, HER2+, stage I tumors.
  • Dr. Tolaney offered her perspective on the impact of strategies being explored in clinical trials, including:
    • The phase III APHINITY trial examining the addition of pertuzumab to adjuvant chemotherapy and trastuzumab (NCT01358877)
    • The phase II WSG-ADAPT phase II trial of 12-week neoadjuvant ado-trastuzumab emtansine (T-DM1) +/- endocrine therapy for early-stage HER2+, hormone receptor–positive breast cancer (NCT01745965)
    • The phase III KAITLIN trial of taxane, trastuzumab + pertuzumab, or T-DM1 + pertuzumab after adjuvant doxorubicin + cyclophosphamide/5-fluorouracil + epirubicin + cyclophosphamide (AC/FEC) (NCT01966471)
       


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

This activity is not approved for AMA PRA Category 1 Credit™.

Supported by educational grants from AstraZeneca, Celgene Corporation, Eisai, Genentech, Genomic Health, Inc., Lilly, Merck & Co., Inc., Nektar Therapeutics, Novartis Pharmaceuticals Corporation, and Puma Biotechnology, Inc.

For further information concerning Lilly grant funding, visit www.lillygrantoffice.com.




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