Wednesday, December 6, 2017, San Antonio, Texas, 7:30 PM – 9:30 PM (Central Time)

Cases from the Community: Clinical Investigators Provide Their Perspectives on Actual Breast Cancer Cases and the Implications of Emerging Research

Send Us A Patient Case For Discussion
Clinicians in practice are invited to submit one or more interesting breast cancer cases for potential discussion. Simply send a brief video recording of yourself (it can be shot with your cell phone) describing the case, along with any questions you have related to it, to SA2017Cases@ResearchToPractice.com. At the meeting we will use a selection of these video cases to generate discussion and debate among our expert panel.

Location:
San Antonio Marriott Rivercenter
101 Bowie Street
San Antonio, TX 78205
Hotel Phone: (210) 223-1000

Time:
7:30 PM – 9:30 PM (Central Time) — Educational Dinner Meeting

Meeting Room:
Grand Ballroom (3rd Floor)

There is no registration fee for this event. However, preregistration is advised, as seating is limited.

Faculty:
Kimberly L Blackwell, MD
Professor of Medicine
Director, Breast Cancer Program
Duke Cancer Institute
Durham, North Carolina

Kathy D Miller, MD
Co-Director, IU Simon Cancer Center Breast Cancer Program
Ballvé-Lantero Scholar in Oncology
Professor of Medicine
Division of Hematology/Oncology
Indiana University
Melvin and Bren Simon Cancer Center 
Indianapolis, Indiana

Joyce O’Shaughnessy, MD
Chair, Breast Cancer Research Program
Baylor Charles A Sammons Cancer Center
Celebrating Women Chair in
Breast Cancer Research
Texas Oncology
US Oncology
Dallas, Texas of Medicine

George W Sledge Jr, MD
Professor of Medicine
Chief, Division of Oncology
Department of Medicine
Stanford University School of Medicine
Stanford, California

Sara M Tolaney, MD, MPH
Dana-Farber Cancer Institute
Associate Director of Clinical Research
Susan F Smith Center for Women's Cancers
Senior Physician
Assistant Professor in Medicine
Harvard Medical School
Boston, Massachusetts

Moderator:
Neil Love, MD
Research To Practice
Miami, Florida



MODULE 1: Management of Newly Diagnosed Localized HER2-Positive Disease — Dr Blackwell

Sample Community Oncologist Case Presentation

A 45-year-old small business owner with a 2.5-cm ER/PR-negative, HER2-positive invasive ductal carcinoma (IDC) under the care of a community surgeon undergoes a lumpectomy and sentinel lymph node biopsy with negative surgical margins. She is found to have 1/3 involved lymph nodes. Her 2-week postoperative medical oncology evaluation reveals that she has healed well with no complications. She has 3 young children.

Sample Case Discussion Questions

  • For a patient such as this one, would you normally recommend neoadjuvant therapy? If pertuzumab is approved as a component of adjuvant therapy, how, if at all, do you believe rates of neoadjuvant therapy may be affected? 
  • Given the findings from the Phase III APHINITY trial, do you believe that pertuzumab should be approved by the FDA for routine clinical use as adjuvant therapy and, if so, for which patients would you prioritize the inclusion of the drug? 
  • How do tumor size, nodal status and ER status factor into your selection of adjuvant therapy for patients with HER2-positive disease? What about your decision to administer neratinib after 1 year of adjuvant HER2-directed therapy?

Faculty Presentation Topics

  • Indications for neoadjuvant systemic therapy and selection of optimal approach 
  • Results from the APHINITY trial evaluating the addition of pertuzumab to chemotherapy and trastuzumab as adjuvant therapy for HER2-positive primary breast cancer
  • FDA approval of neratinib as extended adjuvant therapy; patient selection and clinical factors guiding its use in clinical practice

MODULE 2: Use of Genomic Assays to Assist in Clinical Decision-Making for Patients with ER-Positive Early Breast Cancer (EBC) — Dr Sledge

Sample Community Oncologist Case Presentation

A 66-year-old college professor presents with a 3-cm ER/PR-positive, HER2-negative IDC and 1 palpable, biopsy-proven involved ipsilateral lymph node. Her ECOG performance status (PS) is 0. She has a friend who died of breast cancer 2 years ago and she wants “to do everything” to minimize her risk of relapse.

Sample Case Discussion Questions

  • In general, would you likely order a genomic tumor assay in this situation, and if so, which one? What if the patient’s tumor were 1.2 centimeters? What if she had node-negative disease? What if she were 40 years old?
  • If you were going to order a genomic assay for this patient, would you feel equally comfortable with any of the available testing platforms? In the past year, how many times have you ordered a 21-gene Recurrence Score® (Oncotype DX®), Breast Cancer Index, EndoPredict®, Prosigna® PAM50 or a 70-gene breast cancer recurrence assay (MammaPrint®) for patients with newly diagnosed EBC?
  • In which situations, if any, are you using a genomic assay to guide treatment decision-making in the preoperative setting? If you employ a genomic assay in the neoadjuvant setting, what specific testing platform would you most likely choose?

Faculty Presentation Topics

  • Recent data sets informing the use of molecular profiling to personalize adjuvant therapy for patients with ER-positive EBC
  • Published guidelines and consensus statements regarding the current role of genomic assays in decision-making for patients with node-negative and node-positive, ER-positive EBC
  • Available data with and potential clinical role of genomic assays to guide the use of neoadjuvant therapy

MODULE 3: Selection and Sequence of Therapy for Patients with ER-Positive, HER2-Negative Metastatic Breast Cancer (mBC) — Dr Tolaney

Sample Community Oncologist Case Presentation

A 73-year-old active woman is diagnosed with ER-positive, HER2-negative inflammatory breast cancer with 2 of 15 positive nodes. She receives dose-dense AC → paclitaxel followed by anastrozole but presents with asymptomatic bone and lung metastases 2 years after starting the aromatase inhibitor.

Sample Case Discussion Questions

  • What treatment would you most likely recommend for this patient? Assuming you intended to use a CDK4/6 inhibitor (with endocrine therapy), how would you generally decide between the 3 commercially available agents?  
  • What clinical and biologic factors (menopausal status, symptomatology, comorbidities, treatment-free interval, et cetera) affect your selection of first-line and subsequent therapy for patients with ER-positive mBC? 
  • For which clinical situations, if any, do you generally administer endocrine therapy alone in the first-line setting? For which clinical situations, if any, do you believe it is reasonable to use a CDK4/6 inhibitor as monotherapy?  
  • Is there any reason to believe that any of the available CDK4/6 inhibitors are fundamentally different from the others or may be more or less effective in specific patient populations?

Faculty Presentation Topics

  • Comparative activity, side effects and CNS penetration of available CDK4/6 inhibitors 
  • Recent FDA approvals of ribociclib and abemaciclib and integration into clinical algorithms for ER-positive mBC
  • Available data with and current clinical role of CDK4/6 inhibitors for premenopausal patients
  • Incidence, monitoring and treatment of commonly occurring toxicities in patients receiving CDK4/6 inhibitors

MODULE 4: Protocol and Off-Protocol Decision-Making for Patients with HER2-Positive mBC — Dr Miller

Sample Community Oncologist Case Presentation

A 37-year-old premenopausal software engineer was diagnosed 2 years ago with a 3.1-cm ER/PR-positive, HER2-positive breast cancer and received neoadjuvant docetaxel, trastuzumab and pertuzumab for 6 cycles, achieved a partial response and elected to undergo a bilateral mastectomy and sentinel lymph-node dissection (0/2 positive nodes). She completed 1 year of adjuvant trastuzumab and continued on tamoxifen but recently presented with mild hip pain and 3 small lesions in the liver that are biopsy-proven breast cancer.

Sample Case Discussion Questions

  • What is the optimal front-line treatment approach for a patient with ER-negative, HER2-positive mBC who received pertuzumab in the (neo)adjuvant setting? If pertuzumab is approved as a component of adjuvant therapy, how, if at all, do you believe management of relapsed disease might change? 
  • What is the optimal front-line treatment approach for a patient with ER-positive, HER2-positive mBC? Are there patients with this phenotype for whom chemotherapy can be avoided in favor of dual targeted therapy? 
  • How do you currently approach therapy for patients with HER2-positive brain metastases? Which agents and strategies do you believe are most effective for these individuals?

Faculty Presentation Topics

  • Treatment options for patients experiencing disease progression after receiving pertuzumab/trastuzumab/chemotherapy in the (neo)adjuvant setting 
  • Results of the Phase II TBCRC 022 trial of neratinib/capecitabine for patients with HER2-positive breast cancer and brain metastases; other available agents and strategies with CNS activity 
  • Other novel agents and strategies under development for HER2-positive mBC (neratinib, tucatinib, margetuximab, DS-8201, et cetera)

MODULE 5: Novel Targeted Agents and Other Emerging Therapeutic Strategies — Dr O’Shaughnessy

Sample Community Oncologist Case Presentation

A 67-year-old occupational therapist was diagnosed in 2014 with locally advanced ER/PR-negative, HER2-negative breast cancer and received neoadjuvant dose-dense AC  paclitaxel followed by mastectomy and radiation therapy. Eleven months later she developed a biopsy-proven supraclavicular lymph node recurrence, and a workup revealed liver metastases. She received capecitabine and then eribulin but experienced persistent problems with low blood counts, and a bone marrow biopsy recently revealed tumor infiltration.

Sample Case Discussion Questions

  • Would you recommend genetic testing for this patient at this time? What is the likelihood that this patient would have a germline BRCA1/2 mutation? What about microsatellite instability testing?
  • Would you recommend multiplex testing/next-generation sequencing for this patient at this time? Do you believe there are “targetable” mutations that can be identified in patients with triple-negative mBC?
  • Are there situations in which you would recommend one of the approved anti-PD-1/PD-L1 compounds to a patient with breast cancer outside a clinical trial setting? Would you be considering that type of approach for this patient?
  • What ongoing clinical trials would you likely prioritize for a patient such as this one?

Faculty Presentation Topics

  • Available clinical trial data documenting the presence of genomic alterations in breast cancer and the potential benefit of targeted therapies
  • Published research data documenting the activity of anti-PD-1/PD-L1 antibodies in patients with mBC
  • Ongoing studies of anti-PD-1/PD-L1 antibodies alone or in combination with other systemic therapies 
  • Other promising therapies under investigation

Target Audience:
This activity is intended for medical oncologists, breast cancer surgeons, radiation oncologists and other healthcare professionals involved in the diagnosis and treatment of breast cancer.

Learning Objectives:
At the conclusion of this activity, participants should be able to:

  • Consider published data to guide the use of biomarkers and genomic classifiers to assess risk and customize therapy for patients with hormone receptor-positive breast cancer in the neoadjuvant, adjuvant and extended-adjuvant settings.
  • Appraise available and emerging research evidence to individualize the selection and duration of neoadjuvant and adjuvant chemobiologic regimens for patients with HER2-overexpressing early breast cancer.
  • Implement a long-term clinical plan for the management of metastatic HER2-positive breast cancer, incorporating existing and investigational targeted treatments.
  • Develop an evidence-based algorithm for the treatment of advanced hormone receptor-positive pre- and postmenopausal breast cancer, including the use of endocrine, biologic and chemotherapeutic agents.
  • Consider published research findings and patient preferences in the selection and sequencing of available and investigational therapeutic agents for patients with metastatic ER/PR-negative, HER2-negative breast cancer.
  • Develop an understanding of the mechanisms of action of, available data with and potential clinical roles of novel targeted and immunotherapeutic approaches in preparation for their potential introduction into future breast cancer clinical practice.
  • Identify ongoing trials of investigational approaches in breast cancer, and obtain consent and refer patients for study participation.

CME Credit Form:
A CME credit form will be given to each participant at the conclusion of the activity.

Accreditation Statement:
Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement:
Research To Practice designates this live activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Internal Medicine (ABIM) — Maintenance of Certification (MOC):
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Please note, this program has been specifically designed for the following ABIM specialty: medical oncology.

Personal information and data sharing: Research To Practice aggregates deidentified user data for program-use analysis, program development, activity planning and site improvement. We may provide aggregate and deidentified data to third parties, including commercial supporters. We do not share or sell personally identifiable information to any unaffiliated third parties or commercial supporters. Please see our privacy policy at ResearchToPractice.com/Privacy-Policy for more information. For those clinicians wishing to receive ABIM MOC credit for attending, you will receive an email after the event with instructions.

Disclosure Policy:
Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CME/CNE activities. Conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations. Financial disclosures will be provided in meeting course materials.

Supporters:
This live activity is supported by educational grants from Agendia Inc, AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Genomic Health Inc, Lilly, Novartis and Puma Biotechnology Inc.

San Antonio Marriott Rivercenter
101 Bowie Street
San Antonio, TX 78205
Hotel Phone: (210) 223-1000

Meeting Room:
Grand Ballroom (3rd Floor)

Directions:
The Marriott Rivercenter hotel is conveniently located within walking distance (1.5 blocks) of the Henry B Gonzalez Convention Center.

 

This activity is intended for medical oncologists, breast cancer surgeons, radiation oncologists and other healthcare professionals involved in the diagnosis and treatment of breast cancer.

There is no registration fee for this event. However, preregistration is advised, as seating is limited.

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