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 1.5 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 AstraZeneca, Celgene Corporation, and Merck Sharp & Dohme Corp.

Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer?

Release Date: July 31, 2018
Expiration Date: July 31, 2019
Media: Internet - based
 

Activity Overview

Recent advances have been made in diagnosing and treating triple-negative breast cancer (TNBC). It can be difficult for practicing clinicians to stay current with these emerging data. Through a combination of didactic presentations and interactive discussions, our distinguished panel discusses the challenges involved in the management of TNBC. The panel also provides their insights and perspectives on recent clinical studies and investigational approaches for treatment of TNBC, including sequencing strategies for existing and novel agents and combination therapies.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AstraZeneca, Celgene Corporation, and Merck Sharp & Dohme Corp.

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 oncologists, gynecologic oncologists, and fellows who treat patients with breast cancer. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of breast cancer are also invited to participate.

Learning Objectives

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

  • Discuss the biology of triple-negative breast cancer (TNBC) in the context of standard approaches and unmet clinical needs in the field
  • Explain novel mechanistic approaches under investigation for the treatment of patients with TNBC 
  • Detail current and emerging clinical trial information concerning the use of chemotherapeutic, targeted, and immunotherapeutic approaches to care for patients with TNBC
  • Evaluate recent clinical trial findings and place them in the context of unmet clinical needs, evolving treatment paradigms in the field, and the need for participation in clinical trials evaluating novel TNBC management strategies

Faculty, Staff, and Planners' Disclosure

Moderator

Joyce O'Shaughnessy
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: AstraZeneca, Novartis, Lilly; Speakers Bureau: AstraZeneca, Lilly

Faculty
Tiffany A. Traina
Tiffany A. Traina, MD
Clinical Director, Breast Medicine Service
Section Head, Triple Negative Breast Cancer Clinical Research Program
Memorial Sloan Kettering Cancer Center
Assistant Professor
Weill Cornell Medical College
New York, NY

Disclosure: Consultant: Genentech/Roche, Eisai, Medivation, Pfizer, AstraZeneca, Merck, Astellas Pharma, Puma Biotechnology, Advaxis, Celgene, Innocrin Pharma, Genomic Health, Bristol-Myers Squibb, Samsung; Speakers Bureau: Roche/Genentech; Research Funding: Medivation, Eisai, Pfizer, Novartis, Innocrin Pharma, AstraZeneca, Astellas Pharma

Charles Shapiro
Charles Shapiro, MD
Professor of Medicine
Director, Translational Breast Cancer Research
Director, Survivorship
Icahn School of Medicine at Mount Sinai
New York, NY

Disclosure: Dr. Charles Shapiro has no relevant financial relationships with commercial interests to disclose.

Jenny Chang
Jenny Chang, MD
Director, Methodist Cancer Center
The Methodist Hospital
Houston, TX

Disclosure: Dr. Jenny Chang has no relevant financial relationships with commercial interests to disclose.

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

Disclosure Policy and Resolution of Conflicts of Interest

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 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 and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician or nurse 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™ Recaps

1 of 3
Insights from Tiffany A. Traina, MD, clinical director, Triple Negative Breast Cancer Clinical Research Program at Memorial Sloan Kettering Cancer Center—PER Pulse Recap:
Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer?

In this continuing medical education–certified activity, Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer? expert faculty join program chair Joyce O’Shaughnessy, MD, to discuss the challenges involved in the management of triple-negative breast cancer (TNBC) and recent advances made in diagnosing and treating TNBC. The panel also provides insights and perspectives on recent clinical studies and investigational approaches for treatment, including sequencing strategies for existing and novel agents and combination therapies.

This first of 3 PER Pulse Recaps summarizing the online program focuses on novel mechanistic approaches under investigation for the treatment of patients with TNBC; details current and emerging clinical trial information concerning the use of targeted and immunotherapeutic approaches to care for patients with TNBC; evaluates recent clinical trial findings, placing them in the context of unmet clinical needs and evolving treatment paradigms in the field; and discusses the need for participation in clinical trials evaluating novel TNBC management strategies.

Below are some highlights from the activity featuring Dr. Traina,

  • Presentation of antibody–drug conjugates (ADCs), an emerging targeted drug class that shows great potential for treating patients with TNBC with lower toxicity for heavily pretreated TNBC patients
  • Faculty reviews of the major ongoing trials testing sacituzumab govitecan1, glembatumumab vedotin2, and ladiratuzumab vedotin3 for the treatment of TNBC
  • Panel discussion of real case scenarios of 2 patients with heavily pretreated TNBC, exhibiting pan-metastasis that showed a total response to treatment with ladiratuzumab
  • Faculty approaches to the application of ADC sacituzumab for a heavily pretreated 30-year-old woman with estrogen receptor–refractory tumor and other applications beyond TNBC
  • Discussion of opportunities and combination therapies with immunotherapeutic agents and ADCs as the future for TNBC treatment

“[Regarding antibody–drug conjugates:] This novel engineering of a drug may give us the opportunity to revisit some failed systemic agents in development that perhaps we couldn’t deliver at effective doses systemically due to toxicity, but now we are able to bring a higher concentrated amount right into a tumor.”
—Tiffany A. Traina, MD

References

  1. Bardia A, Mayer IA, Diamond JR, et al. Efficacy and safety of anti-trop-2 antibody drug conjugate sacituzumab govitecan (IMMU-132) in heavily pretreated patients with metastatic triple-negative breast cancer. J Clin Oncol. 2017;35(19):2141–2148. doi: 10.1200/JCO.2016.70.8297.
  2. Yardley DA, Weaver R, Melisko ME, et al. EMERGE: a randomized phase II study of the antibody-drug conjugate glembatumumab vedotin in advanced glycoprotein NMB-expressing breast cancer. J Clin Oncol. 2015;33(14):1609–1619. doi: 10.1200/JCO.2014.56.2959
  3. Modi S, Pusztai L, Forero A, et al. Phase 1 study of the antibody-drug conjugate ladiratuzumab vedotin (SGN-LIV1A) in patients with heavily pretreated triple-negative metastatic breast cancer. Presented at: 2017 San Antonio Breast Cancer Symposium; December 5-9, 2017; San Antonio, TX. Poster PD3-14. sabcs17.posterview.com/nosl/p/PD3-14.

2 of 3
Insights from Charles Shapiro, MD—PER Pulse Recap:
Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer?

As a follow-up to the continuing medical education–certified activity, Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer?, this second of 3 PER Pulse Recaps summarizing the online program focuses on updates to the use of novel PARP inhibitors in different breast cancer settings. Below are some highlights from the activity featuring Dr. Shapiro, professor of medicine and director of Translational Breast Cancer Research at Icahn School of Medicine at Mount Sinai in New York, New York:

  • Promising phase III PARP trials testing olaparib1 in metastatic breast cancer patients with a germline BRCA mutation and talazoparib2 for patients with advanced HER2-negative breast cancer with germline BRCA mutations
  • The rationale for treatment combinations of PARP inhibitors and immunotherapy3
  • Panel discussion of olaparib approval for the metastatic germline population BRCA1/2 and its impact on National Comprehensive Cancer Network guideline updates to support germline testing in breast cancer patients
  • Panel insights on the importance of patient engagement in clinical trials and how to properly select patients for trial participation
  • Discussion of when and how to integrate emerging therapies using PARP inhibitors in clinical practice when treating patients with and without germline mutations using real case scenarios from clinical practice

“These PARP inhibitors, which are much less toxic than chemotherapy, are effective in those who have a germline mutation and BRCA1/BRCA2.”
—Charles Shapiro, MD

References

  1. Robson M, Im SA, Senkus E, et al. olaparib for metastatic breast cancer in patients with a germline BRCA mutation [erratum in N Engl J Med. 2017;Oct 26;377(17):1700. doi: 10.1056/NEJMx170012]. N Engl J Med. 2017;377(6):523-533. doi: 10.1056/NEJMoa1706450
  2. Litton J, Rugo HS1, Ettl J, et al. Talazoparib in Patients with Advanced Breast Cancer and a Germline BRCA Mutation. N Engl J Med. 2018 Aug 23;379(8):753-763. doi: 10.1056/NEJMoa1802905. Epub 2018 Aug 15.
  3. Domchek SM, S Postel-Vinay, Y-J Bang, et al. An open-label, multitumor, phase II basket study of olaparib and durvalumab (MEDIOLA): Results in germline BRCA-mutated (gBRCAm) HER2-negative metastatic breast cancer (MBC)2017 San Antonio Breast Cancer Symposium; December 5-9, 2017; San Antonio, TX. Abstract PD6-11.

3 of 3
Insights from Jenny Chang, MD—PER Pulse Recap:
Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer?

As a follow-up to the continuing medical education–certified activity, Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer? this third of 3 PER Pulse Recaps summarizing the online program focuses on the potential role of immuno-oncology in treating patients with triple-negative breast cancer (TNBC). Below are some highlights from the activity featuring Dr. Chang:

  • Overview of the PD-1 and PD-L1 inhibitors available today and their impact in early and late lines of therapy
  • Discussion of relevant clinical trials exploring the rationale and promises of combinatorial therapies with immune checkpoints together with PARP inhibitors and the safety of these combinations
  • How turning “cold” tumors into “hot” ones may improve response to immunotherapy1
  • Panel discussion of the use of immunotherapy in both the adjuvant and neoadjuvant settings
  • Review of the KEYNOTE-5222 study of pembrolizumab as neoadjuvant therapy followed by pembrolizumab as adjuvant therapy for TNBC

“We can see it can be safely combined, and we do see responses, and you do see clinical benefit with durable responses both in mutated tumors, BRCA-mutated tumors, [and] wild-type tumors. This is a new area, which I think is extremely promising—looking at the combinatorial therapies with immune checkpoints together with PARP inhibitors.”
—Jenny Chang, MD

References

  1. Li J, Byrne KT, Yan F, et al. Tumor cell-intrinsic factors underlie heterogeneity of immune cell infiltration and response to immunotherapy. Immunity. 2018;49(1):178-193e7.
  2. Schmid P, Cortes J, Bergh JCS, et al. KEYNOTE-522: phase III study of pembrolizumab (pembro) + chemotherapy (chemo) vs placebo + chemo as neoadjuvant therapy followed by pembro vs placebo as adjuvant therapy for triple-negative breast cancer (TNBC). J Clin Oncol. 2018;36(suppl 15):TPS602. ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.TPS602.

Insights from Joyce O’Shaughnessy, MD—PER Pulse Recap:
Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer?

As a follow-up to the continuing medical education–certified activity, Medical Crossfire®: Where Are We Headed in the Treatment of Triple-Negative Breast Cancer? this third of 3 PER Pulse Recaps summarizing the online program focuses on AKT inhibitors for patients with triple-negative breast cancer (TNBC). Below are some highlights from the activity featuring Dr. O’Shaughnessy:

  • AKT inhibitors and their potential role in treating patients with TNBC1,2
  • The role of AKT inhibitors in making “cold” tumors “hot” and suitable for immunotherapy
  • Data from preliminary phase II studies—hypothesis generating and very promising
  • Strategies to combine AKT inhibitors with other therapies
  • Panel discussion of the role of next-generation sequencing for clinical management of patients with breast cancer

“AKT inhibitors may be agents that could lead to [making] these cold tumors hot and help with resistance mechanisms.”
—Joyce O’Shaughnessy, MD

References

  1. Dent R, Im S-A, Espie M, et al. Overall survival (OS) update of the double-blind placebo (PBO)-controlled randomized phase 2 LOTUS trial of first-line ipatasertib (IPAT) + paclitaxel (PAC) for locally advanced/metastatic triple-negative breast cancer (mTNBC). Presented at: 2018 American Society of Clinical Oncology Annual Meeting; June 1-5, 2018; Chicago, IL. Abstract 1008. ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.1008.
  2. Kim SB, Dent R, Im SA, et al. Ipatasertib plus paclitaxel versus placebo plus paclitaxel as first-line therapy for metastatic triple-negative breast cancer (LOTUS): a multicenter, randomized, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol. 2017;18:1360-1372. doi: 10.1016/S1470-2045(17)30450-3.

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