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Physicians' Education Resource designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

In-Depth Tumor Board: Biologic Therapy for Breast Cancer

Release Date: September 24, 2008
Expiration Date: September 24, 2009

Publication Overview

Author

PER Editorial Staff

Overview and Purpose

Breast cancer is a heterogeneous disease that displays a wide variety of clinical presentations and pathologic phenotypes. Endocrine therapy and chemotherapy remain the cornerstones of most breast cancer regimens, although novel agents and new formulations of established drugs are being evaluated to improve therapeutic ratios and provide additional treatment options for refractory disease. Biologic agents have emerged as a powerful approach to the treatment of breast cancer: antibodies and small-molecule tyrosine kinase inhibitors (TKIs) against angiogenic and HER-mediated signaling are being actively investigated. These classes of drugs have significantly improved clinical outcomes for patients with advanced or early-stage breast cancer. Additional approaches, including newer HER-targeted agents, the targeting of HER2 signaling components downstream, and the use of conjugated immunotoxins, continue to be developed. However, implementation of these novel therapies needs to be carefully weighed against the potential for toxicity, particularly as these agents move into the adjuvant setting. Careful analysis of existing data will help clinicians incorporate the wide variety of therapeutic options into individualized regimens for the treatment of advanced and early-stage disease.

The purpose of this activity is to inform physicians about current data on established and investigational targeted therapies for breast cancer and the development of individualized regimens that can be incorporated into daily practice.

Target Audience

This activity is intended for medical oncologists involved in the care of patients with breast cancer. No specific skills or knowledge other than a basic training in oncology is required for successful participation in this activity.

Learning Objectives

Upon completion of this educational activity, you should be able to:

  • Assess and apply current data on the effi cacy and safety of anti-HER2 antibody-based therapy in the adjuvant treatment of HER2+ early-stage node-negative breast cancer
  • Analyze current data on the risk of cardiac dysfunction associated with anti-HER2 therapy using antibodies and small-molecule TKIs in breast cancer
  • Discuss current and investigational treatment options for HER2+ metastatic breast cancer (MBC) that had progressed on prior HER2-targeted therapies
  • Evaluate current data on the efficacy and safety of antiangiogenic therapy for MBC
  • Assess current data on the optimization of chemotherapy regimens in the treatment of MBC

Instructions for Participation

  1. Read the following information before entering the educational activity.
  2. Complete the Pre Test
  3. Study the educational activity.
  4. Complete the CME test.
  5. Answer the evaluation questions.
  6. After successful completion of the CME test and evaluation, you will receive your certificate of credit online.
  • CME credit will be granted for only 1 form of participation, either online or via the printed publication.

Read all of the conditions in the Activity Terms box below. You must accept the Activity Terms in order to continue:

Disclosure Policy

It is the policy of Physicians’ Education Resource to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Physicians’ Education Resource requires everyone who is in a position to control the content of an educational activity, including spouses/partners, to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Physicians’ Education Resource has implemented a mechanism to identify and resolve all conflicts of interest prior to the activity.

PER Editorial Staff
No relevant relationships to disclose

Satellite Faculty

José Baselga, MD
Paid Consultant – Exelexis, Inc.

Clifford Hudis, MD
Rresearch Funding – AstraZeneca, Kosan Biosciences, Inc., and Onyx Pharmaceuticals, Inc.
Paid Consultant – Amgen, Bristol-Myers Squibb Company, Genentech, Inc., GlaxoSmithKline, Novartis Pharmaceuticals Corporation, Roche Pharmaceuticals, and sanofi-aventis U.S.
Stock/Investment Holder – Genomic Health, Inc.

Harold Burstein, MD, PhD
No relevant relationships to disclose

This CME activity might include discussion of investigational and/or unlabeled uses of drugs. If the activity includes discussion of investigational and/or unlabeled uses of a drug, specific information is located on the title page. Please refer to the full prescribing information for each drug discussed in this newsletter for FDA–approved dosing, indications, and warnings.

Commercial Support
An educational grant for this activity was provided by Genentech BioOncology.

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Illustration

Signaling from the HER family of receptor tyrosine kinases is often involved in the growth and progression of malignant neoplasias. Homodimerization or heterodimerization of members of the HER family initiates a variety of signal cascades that control key processes such as growth, proliferation, the recruitment of new vasculature, and apoptosis. Research continues to clarify molecular interactions involved in these pathways. For example, binding of epidermal growth factor (EGF) to EGF receptor (EGFR) (HER1) can result in the formation of SOS/GRB2 complexes and the subsequent initiation of Ras/ERK-mediated cell proliferation. PI3K/PIP3/Akt signaling originating from HER activation can also increase cancer cell survival by inhibiting the formation of BAD/BCL-2 and BAD/BCL-XL complexes that normally initiate BAX-mediated apoptosis. Targeted therapies against HER family members have significantly improved clinical outcomes for patients with breast cancer in a variety of settings, and the molecular characterization of HER2 receptor–activated pathways could provide further opportunities for the development of agents designed to reduce cancer cell survival and proliferation.

Disclaimer

The views and opinions expressed in this activity are those of the authors and do not necessarily reflect the views of the sponsor, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this activity to ensure accuracy, the authors, and Physicians’ Education Resource and its servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this activity, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

Please consult full prescribing information for any drugs or procedures discussed within.

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All rights reserved. No part of this activity may be translated, reproduced, stored, or transmitted by any means or in any type of media form including electronic, mechanical photocopying, recording, broadcasting, or otherwise without prior permission from the publisher.

©Copyright 2008 by Physicians’ Education Resource. No material may be reproduced in whole or in part, in any form, without written permission from the publisher.

All correspondence should be directed to:
Editor, In-Depth Tumor Board: Biologic Therapy for Breast Cancer
Physicians’ Education Resource
3500 Maple Ave.
Suite 700
Dallas, TX 75219
Phone: (214) 367–3456
Fax: (214) 367–3304
E–mail: editor@pergrouplp.com