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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 1.0 AMA PRA Category 1 Credit. 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 an educational grant from Pfizer Inc.

Community Practice Connections™: Transforming Treatment Paradigms in Renal Cell Carcinoma: Understanding the Role of Risk Stratification and Emerging Data in the Adjuvant Setting


Release Date: September 28, 2018
Expiration Date: September 28, 2019
Media: Internet - based

Activity Overview

Community Practice Connections™: 17th Annual International Congress on the Future of Breast Cancer® features a summary of clinical evidence guiding best practices in the treatment of patients with early-stage and advanced/metastatic breast cancer. The volume of emerging data and new drug approvals is exploding in breast cancer, creating new challenges for the clinician with regard to understanding how this information impacts treatment strategies for the various breast cancer subtypes.

This educational activity is designed to update you on the latest data that have changed practice, or have the potential to change practice, for hormone receptor‒positive, HER2-positive, and triple-negative breast cancers. In addition, this activity will explore the evolving utility of gene expression assays for guiding treatment decision-making. Didactic summaries are accompanied by short video interviews with internationally recognized experts in the management of breast cancer. The video commentaries address decision points, challenges, and questions that you commonly face in community practice, and provide expert perspectives on the implications of recent data for optimizing outcomes for your patients with breast cancer.

Acknowledgement of Commercial Support

This activity is supported by educational grants from AstraZeneca, Eisai, Inc., Genomic Health, Lilly, Novartis Pharmaceuticals Corporation, Pfizer, and Syndax Pharmaceuticals, Inc.

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

 

Instructions for This Activity and Receiving Credit

  • You will need to login 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 videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video files” will be available for your reference.
  • In order to receive a CME certificate, participants 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. Participants may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational activity is directed toward medical, surgical, and radiation oncologists involved in the treatment of patients with breast cancer. Fellows, nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of breast cancer may also participate.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  • Individualize treatment planning for patients with breast cancer based on the appropriate use and interpretation of biomarker results and molecular or genomic assays
  • Integrate recent clinical trial evidence into personalized treatment strategies for the management of patients with breast cancer
  • Discuss emerging data regarding investigational approaches for managing breast cancer in the context of evolving treatment paradigms
  • Identify variances in care and planned/ongoing clinical trials that are evaluating investigational approaches in breast cancer treatment settings

Faculty, Staff, and Planners' Disclosures

Faculty

Joyce O'Shaughnessy, MD
Celebrating Women Chair in Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology
Co-Chair, Breast Cancer Research Program
The US Oncology Network
Dallas, TX

Disclosure:Consultant: Novartis, AstraZeneca, Celgene, Lilly, Merck, Pfizer, Seattle Genetics

Sara A. 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

Disclosure: Grant/Research Support: Amgen, Bayer, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Pfizer, Roche, Biomarin, Merrimack, OBI Pharma, PUMA, Dignitana, Medivation, Lilly, Novartis; Other: Travel for Lilly, Novartis, OBI

Ian Krop, MD, PhD
Chief, Breast Medical Oncology, Susan F. Smith Center for Women's Cancers
Clinical Research Director, Breast Oncology Center
Senior Physician
Associate Professor of Medicine
Harvard Medical School
Boston, MA

Disclosure: Grant/ Research Support: Genentech/Roche; Consultant: Daiichi Sankyo; Other: Genentech/Roche (Scientific Advisory Board) and spouse employment at AMAG Pharmaceutical

Ingrid A. Mayer, MD, MSCI
Ingram Professor of Cancer Research
Professor of Medicine
Leader, VICC Breast Cancer Research Program
Co-Principal Investigator, VICC Breast Cancer SPORE
Division of Hematology/ Oncology
Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center
Nashville, TN

Disclosure: Grant/Research Support: Novartis, Pfizer; Other: Novartis, Genentech, AstraZeneca (Scientific Advisory Board)

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 creates a 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/CE 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/CE activity is for continuing medical and nursing 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®.

PER Pulse Recap™

PER Pulse Recap (1 of 3)

Community Practice Connections™: 17th Annual International Congress on the Future of Breast Cancer® is a continuing medical education–certified, interactive online activity released on September 28, 2018. In this activity, expert faculty Joyce O’Shaughnessy, MD; Sara Hurvitz, MD; Ingrid Mayer, MD, MSCI; and Ian Krop, MD, PhD, discuss current treatment standards by breast cancer subtype, emerging data that have the potential to affect clinical practice in the near future, and the integration of molecular profiling tools to help individualize therapy.

This first of 3 PER Pulse™ Recaps summarizing the online activity focuses on current standards and emerging treatments for hormone receptor–positive metastatic breast cancer (MBC). Below are some highlights from the activity featuring Dr Mayer:

  • Three CDK4/6 inhibitors (palbociclib, ribociclib, and abemaciclib) have received FDA approval for the treatment of hormone receptor–positive MBC. These agents have demonstrated efficacy in phase III trials in the first-line setting in combination with an aromatase inhibitor (AI) and in patients with progression on an AI, in combination with fulvestrant.
    • Recent data from the MONALEESA-3 trial also provide support for use of ribociclib combined with fulvestrant as a first-line therapy. The addition of ribociclib significantly improved progression-free survival from 18.3 months with fulvestrant alone to median not reached with the combination (HR, 0.577; 95% CI, 0.415-0.802).
    • The MONALEESA-7 trial demonstrated that the CDK4/6 inhibitors can also be used effectively in combination with ovarian suppression plus an AI for premenopausal patients with hormone receptor–positive MBC. Results showed a similar magnitude of benefit with the addition of ribociclib as that in postmenopausal patients (HR, 0.55; P <.0001).
  • The development of stomatitis in patients treated with everolimus plus exemestane has been a clinical challenge, but results from the SWISH study showed that prophylactic use of a steroid-containing oral rinse could substantially reduce the incidence and severity of this adverse event.
  • New cytotoxic agents are also in development for patients who develop resistance to endocrine therapies. A novel antibody–drug conjugate (ADC), sacituzumab govitecan, was evaluated in a phase II trial in heavily pretreated patients with hormone receptor–positive MBC. This ADC produced a response rate of 31% and a clinical benefit rate of 48%, with a median duration of response of 7.4 months.

“We’ve made tremendous advances in the treatment of estrogen receptor–positive metastatic breast cancer with the addition of CDK4/6 inhibitors and mTOR inhibitors to endocrine therapy.”
—Ingrid Mayer, MD, MSCI


PER Pulse Recap (2 of 3)

Community Practice Connections™: 17th Annual International Congress on the Future of Breast Cancer® is a continuing medical education–certified, interactive online activity released on September 28, 2018. In this activity, expert faculty Joyce O’Shaughnessy, MD; Sara Hurvitz, MD; Ingrid Mayer, MD, MSCI; and Ian Krop, MD, PhD, discuss current treatment standards by breast cancer subtype, emerging data that have potential to affect clinical practice in the near future, and the integration of molecular profiling tools to help individualize therapy.

This second of 3 PER Pulse™ Recaps summarizing the online activity focuses on current treatment options and clinical considerations for patients with early-stage or metastatic HER2-positive (HER2+) breast cancer. Below are some highlights from the activity featuring Dr Hurvitz:

  • Results from recent phase III trials have added new adjuvant treatment options for patients with higher-risk HER2+ breast cancer.
    • The phase III ExteNet trial compared extending adjuvant therapy with neratinib for 1 year following completion of standard chemotherapy with 1 year of trastuzumab. Extended therapy with neratinib significantly improved 5-year invasive disease-free survival (iDFS) (90.2% with neratinib vs 87.7% with placebo; HR, 0.73; P =.008). Subset analysis suggested that patients with hormone receptor–positive/HER2+ breast cancer derived the greatest benefit.
    • The phase III adjuvant APHINITY trial investigated standard treatment with an anthracycline/taxane-containing chemotherapy plus trastuzumab with or without concurrent pertuzumab for HER2+ breast cancer. The inclusion of pertuzumab significantly improved 3-year iDFS from 93.2% in the control arm to 94.2% (HR, 0.81; P =.045). Patients with node-positive disease appeared to derive the greatest benefit.
  • Several HER2-targeted tyrosine kinase inhibitors, including neratinib and tucatinib, have shown promising preliminary activity against HER2+ brain metastases, and further evaluations are ongoing.
  • Novel HER2-targeted antibodies are also in clinical development, such as trastuzumab deruxtecan, a new HER2-directed antibody–drug conjugate. A response rate of 64% was reported in a phase I study of patients with previously treated HER2+ metastatic breast cancer (MBC). Interestingly, responses were also observed in a cohort of patients with HER2-low MBC. However, 5 fatal cases of interstitial lung disease/pneumonitis have also been reported.

“The outcome that we can expect for a woman who is diagnosed with HER2-positive breast cancer today is as good or better than [that of] patients who are [given a] diagnosis of HER2-negative disease. HER2-targeted therapies have literally altered the natural history of this disease.”
—Sara Hurvitz, MD


PER Pulse Recap (3 of 3)

Community Practice Connections™: 17th Annual International Congress on the Future of Breast Cancer® is a continuing medical education–certified, interactive online activity released on September 28, 2018. In this activity, expert faculty Joyce O’Shaughnessy, MD; Sara Hurvitz, MD; Ingrid Mayer, MD, MSCI; and Ian Krop, MD, PhD, discuss current treatment standards by breast cancer subtype, emerging data that have potential to affect clinical practice in the near future, and the integration of molecular profiling tools to help individualize therapy.

This third of 3 PER Pulse™ Recaps summarizing the online activity focuses on emerging approaches for patients with BRCA1/2-mutated and/or triple-negative breast cancer (TNBC). Below are some highlights from the activity featuring Dr O’Shaughnessy:

  • There are now 2 phase III trials (OlympiAD and EMBRACA), which have reported a significant improvement in progression-free survival (PFS) for a PARP inhibitor (olaparib and talazoparib, respectively) compared with standard chemotherapy in patients with an anthracycline- and taxane-pretreated, BRCA1/2-mutated metastatic breast cancer (MBC). Based on these results, olaparib has received FDA approval for this indication, and talazoparib is undergoing regulatory review.
  • Immune checkpoint inhibitors are beginning to show promise in TNBC. In early-phase trials, responses have been observed in approximately one-fourth of patients treated with single-agent pembrolizumab or atezolizumab in the first-line setting.
    • More recently, a press release reported that the first-line IMpassion130 trial comparing nab-paclitaxel with atezolizumab or placebo in metastatic TNBC was positive, showing a significant improvement in PFS with atezolizumab in the intention-to-treat and PD-L1–positive populations; full results are expected to be presented at an upcoming scientific meeting.
    • Ongoing phase III trials are also evaluating pembrolizumab as a single agent and in combination with chemotherapy for metastatic TNBC.
  • Several novel antibody–drug conjugates (ADCs) are also being developed for TNBC, including the TROP-2–targeted ADC sacituzumab govitecan and the LIV-1–directed ADC ladiratuzumab vedotin. Both agents have demonstrated promising preliminary activity in phase I/II trials.
  •  
  • AKT inhibitors are also being actively explored for the treatment of metastatic TNBC.
    • In the randomized phase II LOTUS trial, the addition of ipatasertib to paclitaxel was associated with a small but statistically significant improvement in PFS in the intention-to-treat population. However, in patients whose tumors had an alteration in either PIK3CA, AKT1, or PTEN, median PFS was nearly doubled (9.0 months vs 4.9 months; HR, 0.44; 95% CI, 0.20-0.99).
    • Results from a randomized phase II trial also showed a significant improvement in PFS for the combination of capivasertib and paclitaxel in patients with PIK3CA-, AKT1-, or PTEN-altered TNBC (9.3 months vs 3.7 months; HR, 0.30; P =.01).

“It’s pretty clear that combining the [immune] checkpoint inhibitors with chemotherapy is going to be the way forward for us in metastatic triple-negative breast cancer.”
—Joyce O’Shaughnessy, MD







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