Accreditation/Credit Designation

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

Physicians' Education Resource®, LLC, designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AbbVie Inc., AstraZeneca, Celgene Corporation, Daiichi Sankyo, Inc., Eisai, Genentech, Inc., Genomic Health, Inc., Lilly, Merck Sharp & Dohme Corp, Novartis Pharmaceuticals Corporation, Pacira Pharmaceuticals, Inc., Pfizer, Puma Biotechnology, Inc., and Seattle Genetics, Inc.

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

36th Annual Miami Breast Cancer Conference® Clinical Case Vignette Series


Release Date: May 31, 2019
Expiration Date: May 31, 2020
Media: Internet - based

Activity Overview

Strategies for achieving the best possible outcomes for patients with breast cancer are prone to rapid change because of the pace at which advances in patient care across the cancer care continuum emerge. The Annual Miami Breast Cancer Conference® brings together breast cancer specialists to highlight state-of-the-art multidisciplinary patient care. This year’s conference was no exception, with an agenda that featured clinical updates in local, regional, and systemic therapies; timely practice management and policy concerns; exploration of clinical controversies; patient-centered care (eg, patient‒clinician communication, care of the older patient, psychosocial concerns, pain); and much more.

This online CME/CE-certified educational activity based on content presented at the 36th Annual Miami Breast Cancer Conference® consists of a series of interviews with Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C); Sara Hurvitz, MD; Hope S. Rugo, MD, FASCO; and Joseph A. Sparano, MD, during which they discuss their approaches toward clinical cases and other topics important to the practicing community clinician. Specifically, these renowned experts review current and emerging evidence on local and systemic therapies for various breast cancer subtypes, as well as a thought-provoking exploration of current and emerging clinical utilities of molecular testing for breast cancer.

CME Activity Table of Contents

  • Pretest
  • Module 1: Surgical Decision-Making for Early-Stage Breast Cancer
    Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)
  • Module 2: A Patient With Stage I or IIA HER2+ Breast Cancer
    Sara Hurvitz, MD
  • Module 3: Fourth-Line Therapy for a Patient With HR-Negative, HER2+ Metastatic Breast Cancer
    Sara Hurvitz, MD
  • Module 4: Triple-Negative Breast Cancer
    Hope S. Rugo, MD, FASCO
  • Module 5: ER+ Breast Cancer
    Joseph A. Sparano, MD
  • Posttest

Acknowledgement of Commercial Support

The 36th Annual Miami Breast Cancer Conference® is supported by educational grants from AbbVie Inc., AstraZeneca, Celgene Corporation, Daiichi Sankyo, Inc., Eisai, Genentech, Inc., Genomic Health, Inc., Lilly, Merck Sharp & Dohme Corp, Novartis Pharmaceuticals Corporation, Pacira Pharmaceuticals, Inc., Pfizer, Puma Biotechnology, Inc., and Seattle Genetics, Inc.

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

Instructions for This Activity and Receiving Credit

  • You will need to log in to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review audio files/content until you finish the presentation.
  • At the end of the activity, educational content/audio files will be available for your reference.
  • In order to receive a CME certificate, you must complete the activity.
  • Complete the Posttest and pass with a score of 70% or higher, complete the Evaluation, and then click on “Request for Credit.” You may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational program is directed toward medical, surgical, and radiation oncologists involved in the treatment of patients with breast cancer. Fellows, nurse practitioners, nurses, physician assistants, researchers, and other healthcare professionals interested in the treatment of breast cancer are also invited to attend.

Learning Objectives

Upon successful completion of this educational program, you should be better prepared to:

  • Incorporate molecular and genomic biomarkers, multigene prognostic assays, and tumor subtype information in appropriate patients to inform clinical decision-making and optimize outcomes for individual patients
  • Summarize expert guidelines and evidence from clinical trials that support the use of genomic and molecular tools to individualize and inform treatment decisions for patients with early and advanced stages of breast cancer
  • Coordinate evidence-based multimodal treatment strategies, integrating surgery, radiation, and systemic therapy when appropriate, to optimize outcomes for patients with nonmetastatic breast cancer
  • Implement multidisciplinary strategies to prevent, mitigate, or manage treatment-related adverse events for patients with breast cancer
  • Integrate recent clinical trial data and expert guidelines into evolving treatment standards in order to provide state-of-the-art care for patients with breast cancer

Faculty, Staff, and Planners’ Disclosures

Anees B. Chagpar
Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)
Professor of Surgery (Oncology)
Assistant Director, Global Oncology
Yale Comprehensive Cancer Center
New Haven, CT

Disclosures: Other: Oncotype

Sara Hurvitz
Sara Hurvitz, MD
Associate Professor of Medicine, Division of Hematology/Oncology
Director, Breast Cancer Clinical Research Program
Co-Director, Santa Monica–UCLA Outpatient Hematology/Oncology Practice
David Geffen School of Medicine at UCLA
Santa Monica, CA

Disclosures: Grant/Research Support: Ambryx, Amgen, Bayer, BI Pharma, BioMarin, Cascadian, Daiichi Sankyo, Dignitana, Genentech, GlaxoSmithKline, Lilly, Macrogenics, Medivation, Merrimack, Novartis, OBI Pharma, Pfizer, Pieris, Puma, Roche, Seattle Genetics; Other: Travel – Lilly, Novartis, OBI Pharma.

Hope S. Rugo
Hope S. Rugo, MD, FASCO
Professor of Medicine
Director, Breast Oncology and Clinical Trials Education
University of California San Francisco
Helen Diller Family Comprehensive Cancer Center
San Francisco, CA

Disclosures: Grant/Research Support: Pfizer, Merck, Novartis, Lilly, Genentech, OBI Pharma, Plexxikon, Odonate, Daiichi Sankyo, Eisai, MacroGenics; Other: Travel – Mylan, Amgen, Puma, Lilly, Merck.

Joseph A. Sparano
Joseph A. Sparano, MD
Professor Medicine & Women's Health
Albert Einstein College of Medicine
Montefiore Medical Center
Bronx, NY

Disclosures: Grant/Research Support: Deciphera, Prescient Therapeutics; Consultant: AstraZeneca, Novartis, Pfizer, Genentech/Roche, Eli Lilly, Celldex, Juno, Adgero; Shareholder: MetaStat.

The staff of Physicians' Education Resource®, LLC (PER®), have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest (COI).

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic, treatment, or management options for a specific patient’s medical condition.

The opinions expressed in the content are solely those of the individual faculty members, and do not reflect those of PER® or any of the companies that provided commercial support for this program.

PER Pulse Recaps

1 of 3
Insight from Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)—PER Pulse™ Recap:
36th Annual Miami Breast Cancer Conference®: Clinical Case Vignette Series

36th Annual Miami Breast Cancer Conference®: Clinical Case Vignette Series is a series of short audio interviews with faculty from the live conference who address a variety of questions commonly faced by practicing community oncologists via discussion of clinical vignettes on:

  • Surgical Decision Making for Early-Stage Breast Cancer
    Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)
  • A Patient With Stage I or IIa HER2-Positive Breast Cancer
    Sara Hurvitz, MD
  • Fourth-Line Therapy for a Patient With HR-Negative, HER2-Positive Metastatic Breast Cancer
    Sara Hurvitz, MD
  • Triple-Negative Breast Cancer
    Hope S. Rugo, MD, FASCO
  • ER-Positive Breast Cancer
    Joseph A. Sparano, MD

Throughout the activity, these physicians answer questions about their decisions for case management and offer perspective and guidance on issues important to community-based physicians.

This first of 3 PER Pulse™ Recaps summarizing the program focuses on Dr Chagpar’s answers to questions about surgical decision making in early-stage breast cancer. During her interview, Dr Chagpar:

  • Discusses her approach toward a 75-year-old woman presenting with grade 2 estrogen receptor–positive (ER+), progesterone receptor (PR+)–positive, HER2-invasive ductal carcinoma, including the role of magnetic resonance imaging, mastectomy, sentinel lymph node biopsy (SLNB), predictive multigene testing, radiation therapy, endocrine therapy, continued breast imaging, and family genetic counseling
  • Reviews her perspectives on achieving a positive margin for patients with breast cancer, particularly for invasive ductal and ductal carcinoma in situ, as well as the importance of cavity shave margin and its application in a 60-year-old woman with a 1.2-cm, ER+, PR+, HER2-negative breast cancer who underwent a partial mastectomy and SLNB
  • Shares her approach toward a 50-year-old woman with triple-negative breast cancer and a 5-cm tumor with 1 positive lymph node who achieved complete clinical and radiographic response after systemic therapy, including facilitating local control and cosmesis and the impact of SLNB false-negative rates on reducing survival and/or locoregional recurrence

“[Positive margins] are associated with a 2-fold risk of having ipsilateral breast tumor recurrence.…We now have randomized controlled trial data to suggest that if we take cavity shave margins at the first operation, we can cut the rate of positive margins in half. We can prevent having a positive margin and prevent having to go back.”

—Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)


2 of 3
Insight from Sara Hurvitz, MD—PER Pulse™ Recap:
36th Annual Miami Breast Cancer Conference®: Clinical Case Vignette Series

36th Annual Miami Breast Cancer Conference®: Clinical Case Vignette Series is a series of short audio interviews with faculty from the live conference who address a variety of questions commonly faced by practicing community oncologists via discussion of clinical vignettes on:

  • Surgical Decision Making for Early-Stage Breast Cancer
    Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)
  • A Patient With Stage I or IIa HER2-Positive Breast Cancer
    Sara Hurvitz, MD
  • Fourth-Line Therapy for a Patient With HR-Negative, HER2-Positive Metastatic Breast Cancer
    Sara Hurvitz, MD
  • Triple-Negative Breast Cancer
    Hope S. Rugo, MD, FASCO
  • ER-Positive Breast Cancer
    Joseph A. Sparano, MD

Throughout the activity, these physicians answer questions about their decisions for case management and offer perspective and guidance on issues important to community-based physicians.

This second of 3 PER Pulse™ Recaps summarizing the program focuses on Dr Hurvitz’s answers to questions about management of stage I/IIa HER2-positive (HER2+) breast cancer. During her interview, Dr Hurvitz:

  • Discusses her initial approach toward a 30-year-old woman with early-stage HER2+ invasive ductal carcinoma, including decision making around neoadjuvant therapy, based on data from the phase II NeoSphere and TRYPHAENA trials, use of adjuvant radiation therapy, and maintenance treatment, as well as how her choice of treatment may differ for a 68-year-old woman in a similar clinical situation
  • Reviews data from trials of extended adjuvant therapy for HER2+ breast cancer and their impact on her treatment decisions:
    • The ExteNET trial of neratinib versus placebo among women with HER2+ breast cancer who had completed 1 year of adjuvant trastuzumab demonstrated significantly improved invasive disease–free survival in the neratinib group and the ER-positive subgroup.
    • The phase II CONTROL trial—initiated in response to the high rates of grade 3 diarrhea in the ExteNET trial—of loperamide prophylaxis with or without budesonide or colestipol among with patients with HER2+ breast cancer taking neratinib demonstrated significantly reduced rates of high-grade diarrhea.

“The benefit of the neoadjuvant approach is that you can use the response to guide how much you treat the patient. We know that patients who have a pathologic complete response in the breast and nodes at the time of surgery have excellent outcomes.”

—Sara Hurvitz, MD


3 of 3
Insight from Hope S. Rugo, MD, FASCO—PER Pulse™ Recap:
36th Annual Miami Breast Cancer Conference®: Clinical Case Vignette Series

36th Annual Miami Breast Cancer Conference®: Clinical Case Vignette Series is a series of short audio interviews with faculty from the live conference who address a variety of questions commonly faced by practicing community oncologists via discussion of clinical vignettes on:

  • Surgical Decision Making for Early-Stage Breast Cancer
    Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FACS, FRCS(C)
  • A Patient With Stage I or IIa HER2-Positive Breast Cancer
    Sara Hurvitz, MD
  • Fourth-Line Therapy for a Patient With HR-Negative, HER2-Positive Metastatic Breast Cancer
    Sara Hurvitz, MD
  • Triple-Negative Breast Cancer
    Hope S. Rugo, MD, FASCO
  • ER-Positive Breast Cancer
    Joseph A. Sparano, MD

Throughout the activity, these physicians answer questions about their decisions for case management and offer perspective and guidance on issues important to community-based physicians.

This third of 3 PER Pulse™ Recaps summarizing the program focuses on Dr Rugo’s answers to questions about therapy for triple-negative breast cancer (TNBC). During her interview, Dr. Rugo:

  • Discusses her approach toward a 36-year-old woman with T3N1M0, grade 3 TNBC, including preoperative chemotherapy and associated toxicities, treating patients with germline mutations, and ongoing clinical trials using immunotherapy in TNBC
  • Highlights options for subsequent lines of therapy and other investigational agents for advanced TNBC, including:
    • Interim data from the phase III IMpassion130 trial of atezolizumab plus nab-paclitaxel for patients with advanced, HER2-negative, TNBC, in which the subset of patients with PD-L1-positive tumors achieved a 2.5-month and 9.5-month improvement in progression-free survival and overall survival, respectively
    • Antibody–drug conjugate (ADC) sacituzumab govitecan, currently being investigated versus treatment of physician’s choice among patients with TNBC who have received >2 lines of prior chemotherapy
    • Ladiratuzumab vedotin, another ADC in an ongoing phase II trial for TNBC
  • Discusses her perspectives on a case involving a 45-year-old woman with grade 3 TNBC and metastasis to the liver, including the use of immunotherapy, managing immune-related adverse events, and educating patients

“It’s clear that we need to institute [immunotherapy] early in the course of treatment of metastatic disease. And even if [patients’] cancers are progressing sooner than we would like, they still can gain a survival benefit from receiving a checkpoint inhibitor.”

—Hope S. Rugo, MD, FASCO


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