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Efficacy and Safety Considerations in the Treatment of a Patient With HER2-Positive Early-Stage Breast Cancer
Oncology Consultations Vol. 5, No. 3

Release Date: March 17, 2009
Expiration Date: March 17, 2010

Publication Overview

Authors

Clifford Hudis, MD; Mark Pegram, MD

Overview and Purpose

The development of HER2-targeted agents has greatly impacted the treatment of HER2+ early-stage breast cancer. Randomized trials have demonstrated that trastuzumab, a humanized monoclonal antibody targeting HER2, significantly improves survival in patients with HER2+ early-stage disease, regardless of nodal status. Trastuzumab has been evaluated primarily following anthracycline-containing chemotherapy, however, and concerns about increased cardiotoxicity using these agents have generated debate regarding their use in lower-risk patients, such as those with no nodal involvement. The presence of associated comorbidities in these patients can further complicate treatment decisions. Research continues to identify tumor characteristics that might predict the efficacy of particular therapies and to evaluate non–anthracycline-based HER2-targeted regimens that could provide similarly effective but safer treatment options. Further work is needed to fully optimize current therapies used for HER2+ early-stage breast cancer, but careful review of existing data will help practicing oncologists maximize the effectiveness of current treatment strategies while minimizing the occurrence of potentially dangerous adverse events.

The purpose of this activity is to update physicians on current data on the use of HER2-targeted therapies in the treatment of HER2+ early-stage breast cancer and to highlight new developments regarding alternative regimens and predictive assays that could potentially improve the therapeutic index of these approaches.

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 relative efficacy and safety of anthracycline-containing compared to non–anthracycline-containing anti-HER2 antibody–based regimens in HER2+ early-stage breast cancer
  • Discuss the role of TOP2A gene aberration or topoisomerase IIα expression in predicting sensitivity to anthracycline-based chemotherapy in breast cancer
  • Discuss the potential for cardiac toxicity associated with adjuvant HER2-targeted therapy, including cardiac monitoring and associated risk factors

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 Posttest.
  5. Answer the evaluation questions.
  6. After completion of the Pretest and successful completion of the Posttest and evaluation, you will receive your certificate online.

You will be permitted 2 attempts to successfully complete the Posttest.

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

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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.

Clifford Hudis, MD
Research Funding – AstraZeneca; Bristol-Myers Squibb Company; Onyx Pharmaceuticals, Inc.
Paid Consultant – Amgen; Bristol-Myers Squibb Company; Genentech, Inc.; GlaxoSmithKline; Pfizer Inc.; sanofi-aventis U.S.

Mark Pegram, MD
Paid Consultant – Genentech, Inc.; 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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All correspondence should be directed to:
Editor, Efficacy and Safety Considerations in the Treatment of a Patient With HER2-Positive
   Early-Stage Breast Cancer
Physicians’ Education Resource
 3500 Maple Ave.
Suite 700
Dallas, TX 75219
Phone: (214) 367–3400
Fax: (214) 367–3304
E–mail: editor@cancerlearning.com

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Educational Grants

An educational grant for this activity was provided by:


  1. Genentech BioOncology