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Biological Therapy of Breast Cancer Vol. 9, No. 2

Release Date: November 25, 2008
Expiration Date: November 25, 2009

Publication Overview

Authors

Alison Stopeck, MD; Beth Overmoyer, MD, FACP; Rachel Swart, MD, PhD

Overview and Purpose

As the understanding of tumor biology increases, so does the number of targeted agents for the treatment of breast cancer. Although many of these agents have demonstrated efficacy in both early-stage and advanced disease, many questions remain. For patients with HER2+ breast cancer, disease progression following prior HER2-targeted therapy is common, and several recent studies have addressed the optimal therapeutic options for this patient population. These strategies, including incorporation of agents targeting HER2-related pathways, must be carefully examined in comparison with traditional HER2-targeted therapy. Antiangiogenic therapy has also become a major component of breast cancer therapy, although the appropriate cytotoxic partners must be chosen to optimize effectiveness and minimize toxicity. The next generation of targeted agents is directed at several signaling pathways important in breast cancer development and progression, and several of these novel inhibitors are demonstrating activity in patients with advanced disease. As these targeted agents are increasingly combined in breast cancer treatment regimens, the rationale behind these combinations and the benefit/risk ratio for each clinical scenario will have to be carefully examined. Ultimately, the increase in the use of targeted agents for breast cancer will result in better individualization of therapy and improved disease outcome.

The purpose of this activity is to update physicians on preclinical and clinical data concerning the rationale and efficacy of targeted agents in the treatment of patients with breast cancer.

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:

  • Evaluate the safety and efficacy of HER2-targeted agents, including novel HER2-targeted therapies, in patients with HER2+ breast cancer
  • Assess the current status of antiangiogenic therapy, including evaluation of the latest safety and efficacy data on antiangiogenic agents in combination with traditional cytotoxics as well as novel targeted agents, in patients with breast cancer
  • Examine novel biologic agents targeting new signaling pathways involved in breast cancer development and progression currently under investigation
  • Discuss the use of anthracyclines, including the potential effect of HER2 and topoisomerase IIα status on tumor sensitivity to anthracycline-based chemotherapy, in the treatment of patients with breast cancer

Instructions for Participation

  1. Read the following information before entering the educational activity.
  2. Complete the Pretest.
  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.

Rachel Swart, MD, PhD
Paid Consultant – Genomic Health, Inc.
Speaker’s Bureau – Genomic Health, Inc.

Alison Stopeck, MD
Speaker’s Bureau – AstraZeneca, GlaxoSmithKline

Beth Overmoyer, MD, FACP
Paid Consultant – GlaxoSmithKline, sanofi-aventis U.S.

PER Editorial Staff
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 online 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

ERBB2 gene amplification, which can be visualized with fluorescence in situ hybridization, is a strong prognostic indicator for increased tumor aggressiveness and decreased survival in patients with breast cancer. ErbB2 status also serves as a predictive marker of benefit from ErbB2-targeted therapies, which have significantly improved disease outcome in patients with ErbB2+ breast cancer compared to chemotherapy alone. Several studies suggest that ERBB2 amplification might also be associated with benefit from anthracycline-based chemotherapy, potentially expanding its utility as a predictive marker for breast cancer. Amplification of ERBB2 is commonly associated with coamplification of the TOP2A gene locus, which is
located near the ERBB2 gene on chromosome 17. The product of TOP2A, topoisomerase IIα, is a target of inhibitors such as anthracyclines and might be a potential predictive marker of sensitivity to these types of chemotherapeutic agents. Ongoing research is examining the relationship between ERBB2 and TOP2A gene amplification and the optimal use of anthracycline-based therapy in patients with breast cancer.

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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Editor, Biological Therapy of Breast Cancer
Physicians’ Education Resource
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