Medical Crossfire®: A Critical Assessment of Current and Emerging Data Sets to Move Treatment of Triple-Negative Breast Cancer Forward

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

Activity Overview

Triple-negative breast cancer (TNBC) poses significant management challenges because it is aggressive, heterogeneous, and associated with poor survival compared with other breast cancer subtypes. A large amount of data has been generated from clinical trials of investigational approaches to treating metastatic TNBC (mTNBC). Nonetheless, the current standard of care remains sequential chemotherapy, often with single agents. With exciting new advances in our understanding of TNBC, as well as promising emerging therapies, it is important that your patients receive the best possible care using available agents, and that you are poised to integrate new therapies into practice if and when they are approved for use. During the Medical Crossfire^®: A Critical Assessment of Current and Emerging Data Sets to Move Treatment of Triple-Negative Breast Cancer Forward educational activity, expert breast cancer faculty review their best practices for mTNBC, and share their perspectives on the latest data and factors that have the potential to significantly change your clinical practice.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Eisai, Inc.

Target Audience

This educational activity is directed toward medical oncologists who treat patients with breast cancer. Other physicians, 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 activity, you should be better prepared to:

• Detail the biological characteristics of metastatic triple-negative breast cancer (mTNBC), as well as related standard treatment approaches and unmet clinical needs
• Design treatment plans across multiple lines of therapy that integrate the best available clinical data and practice recommendations
• Describe the mechanistic bases for standard therapies used to treat mTNBC across multiple lines of therapy, as well as for investigational strategies being explored for this disease setting
• Evaluate the results of recent clinical trials utilizing chemotherapy, targeted agents, and immunotherapies for mTNBC in the context of existing unmet needs, individualized treatment approaches, and the value of clinical trial participation as a treatment option

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

Disclosures: Consultant/Advisory Board: Novartis, AstraZeneca, Celgene, Lilly, Merck, Pfizer, Seattle

Adam M. Brufsky, MD, PhD
Professor of Medicine
Chief, Division of Hematology/Oncology
Co-Director, Comprehensive Breast Cancer Center
Associate Director, Clinical Investigation
University of Pittsburgh
Pittsburgh, PA

Disclosures: Consultant/Advisory Board: Bioarray Genetics, Novartis, Roche, Eisai, Celgene, Lilly, Pfizer, Agendia, Genomic Health, NanoString Technologies, Biotheranostics

Heather L. McArthur, MD, MPH
Medical Director, Breast Oncology
Samuel Oschin Comprehensive Cancer Institute
Cedars-Sinai Medical Center
Los Angeles, CA

Disclosures: Grant/Research Support: Bristol-Myers Squibb, MedImmune, Ziopharm Oncology, Merck, Lilly; Consultant/Advisory Board: Genentech, Merck, Spectrum Pharmaceuticals, Syndax, OBI Pharma, Calithera Biosciences, Roche, Lilly, Peregrine Pharmaceuticals, TapImmune Inc., Amgen, Puma Biotech, Immunomedics, Pfizer

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

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

The staff of 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 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 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

In this continuing medical education (CME)–certified activity, Medical Crossfire^®: A Critical Assessment of Current and Emerging Data Sets to Move Treatment of Triple-Negative Breast Cancer Forward, expert faculty join moderator Joyce O’Shaughnessy, MD, to discuss the standards of care and best practices for managing metastatic triple-negative breast cancer (mTNBC), as well as emerging data on novel agents and immunotherapy that have the potential to significantly change clinical practice.
 
This first of 3 PER Pulse™ Recaps summarizing the online program focuses on the current guideline recommendations and standard of care for patients with mTNBC. Below are some highlights from the activity featuring Dr Brufsky’s discussion of:

• Single-agent versus multiagent chemotherapy regimens and treatment selection and sequencing of cytotoxic agents and expected efficacies, including first-line nab-paclitaxel/carboplatin (phase II tnAcity trial), overall survival benefits associated with eribulin in heavily pretreated mTNBC, and other real-world data
• The use of PARP inhibition in the treatment of mTNBC, including olaparib (phase III OlympiAD trial), talazoparib (phase III EMBRACA trial), veliparib plus carboplatin/paclitaxel (phase II BROCADE-2 and phase III BROCADE-3 trials), niraparib (phase III BRAVO trial), and rucaparib (phase II RUBY trial)
• Bevacizumab efficacy in managing mTNBC, along with guidance on best practices for patient selection
• Best practices for managing toxicities associated with the use of chemotherapy, eribulin, PARP inhibitors, and bevacizumab and best practices to maximize patients’ ability to stay on therapy and remain eligible for late lines of therapy

2 of 3

As a follow-up to the continuing medical education (CME)–certified activity Medical Crossfire^®: A Critical Assessment of Current and Emerging Data Sets to Move Treatment of Triple-Negative Breast Cancer Forward, this second of 3 PER Pulse™ Recaps summarizing the online program focuses on the anticipated impact of immunotherapy on the treatment landscape for metastatic triple-negative breast cancer (mTNBC). Below are some highlights from the activity featuring Dr McArthur’s discussion of:

• Available data and ongoing trials for single-agent and combinations of immune checkpoint inhibition (ICPi) in mTNBC, including:
  • The most recent phase III IMpassion130 trial update of atezolizumab plus nab-paclitaxel
  • Pembrolizumab plus eribulin in the phase Ib/II ENHANCE/KEYNOTE-150 trial
  • Pembrolizumab plus niraparib in the phase II TOPACIO/KEYNOTE-162 trials
• How ICPis may affect the role of chemotherapy in treating mTNBC and how they will be used in the context of available and emerging therapies, including chemotherapy, antibody–drug conjugates, and PARP inhibition
• Predictive biomarkers for ICPis in mTNBC and how to select patients to receive immunotherapy versus other available therapies, as well as common immune-related adverse events and risk mitigation strategies

3 of 3

As a follow-up to the continuing medical education (CME)–certified activity Medical Crossfire®: A Critical Assessment of Current and Emerging Data Sets to Move Treatment of Triple-Negative Breast Cancer Forward, this third of 3 PER Pulse™ Recaps summarizing the online program focuses on emerging novel agents for the treatment of metastatic triple-negative breast cancer (TNBC). Below are some highlights from the activity featuring Dr Sparano’s discussion of:

• Androgen receptor–targeted single-agent and combination therapies, including phase II trial data on enzalutamide, as well as the faculty’s personal experience using them for the treatment of mTNBC
• Antibody–drug conjugates, their general mechanism of action, available data in mTNBC, and ongoing trials including sacituzumab govitecan in phase II trial, resulting and ongoing phase III ASCENT trial
• Available data on the use of AKT inhibitors in the treatment of mTNBC, including the PAKT study of first-line capivasertib (AZD5363) plus paclitaxel and first-line ipatasertib plus paclitaxel in the phase II LOTUS study and the ongoing randomized phase III IPATunity trial
• Best practices for managing associated toxicities to maximize patients’ ability to stay on therapy and remain eligible for late lines of therapy