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New Developments in Endocrine Therapy and Bone-Targeted Agents for Breast Cancer
Cancer Summaries & Commentaries Vol. 2, No. 1

This activity is not sanctioned by, nor a part of, the 31st Annual San Antonio Breast Cancer Symposium.

1 AMA PRA Category 1 Credit(s)™
Release Date: April 1, 2009
Expiration Date: April 1, 2010

Publication Overview

Authors

Medical writer: Paul Card, PhD; Medical writer: Timothy Quill, PhD; Medical writer: Tristin Abair, PhD; Reviewed by: Debu Tripathy, MD

Overview and Purpose

Endocrine therapy has greatly improved outcomes in women with hormone receptor–positive breast cancer, but controversies and questions still exist regarding the optimal use of hormonal agents. These include whether postmenopausal women should receive up-front aromatase inhibitors (AIs) alone rather than as part of a switching strategy involving selective estrogen receptor modulators (SERMs) and if the previously established benefits from the use of up-front AIs compared to SERMs apply to all classes of AIs. Clinical trials are investigating these and other issues related to the use of endocrine therapy for breast cancer. The potential utility of combining endocrine therapy with HER-targeted agents is being evaluated in the treatment of hormone receptor–positive/HER2+ disease, and the extent of benefit from the use of up-front bone-targeted agents for the prevention of bone loss and fractures resulting from adjuvant AI therapy has been extensively studied. Novel strategies, such as the use of low- compared to standard-dose estrogen for eliciting tumor responses in patients with acquired resistance to AIs, have also been evaluated. Results from studies investigating these issues have been recently presented, and these data will provide oncologists with valuable information on incorporating these highly effective agents into treatment protocols in an effort to reduce the risk of recurrence while maintaining the greatest possible degree of overall health in patients with breast cancer.

The purpose of this activity is to update physicians on the use of endocrine therapy and bone-targeted agents as well as associated bone-related complications arising from therapy in the management of breast cancer and to highlight key issues involved in the selection of treatment plans based on recently presented clinical trial data.

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:

  • Compare adjuvant therapy with an up-front AI to that with a SERM or with sequencing strategies using these 2 classes of agents in postmenopausal women with hormone receptor–positive breast cancer
  • Compare adjuvant therapy with an up-front irreversible steroidal AI to that with a SERM in postmenopausal women with hormone receptor–positive, early-stage breast cancer
  • Evaluate the efficacy and safety of up-front and delayed administration of bisphosphonate therapy in postmenopausal women receiving adjuvant AI therapy for hormone receptor–positive breast cancer
  • Assess the efficacy and safety of bisphosphonate therapy for patients at moderate or higher risk for fragility fractures receiving adjuvant AI therapy for hormone receptor–positive breast cancer
  • Evaluate the efficacy and safety of combining an AI with a small-molecule epidermal growth factor receptor/HER2 inhibitor as first-line therapy for postmenopausal women with hormone receptor–positive advanced breast cancer
  • Assess the efficacy and safety of low-dose compared to high-dose steroidal estrogen in postmenopausal women with hormone receptor–positive metastatic breast cancer that has progressed following AI therapy

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.

Complete the test(s) and evaluation by April 1, 2010 to receive your certificate online.

Read all of the conditions in the Activity Terms box below. You must accept the CME 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.

Kimberly Blackwell, MD
Research Funding – Abraxis Bioscience, LLC; Bristol-Myers Squibb Company; Genentech, Inc.; GlaxoSmithKline
Paid Consultant – Novartis Pharmaceuticals Corporation
Speaker’s Bureau – Novartis Pharmaceuticals Corporation, 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 Novartis Oncology.

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Illustration

For hormone receptor–positive breast cancer, complex interactions between signaling pathways greatly affect tumor progression and bone health. Bone maintenance results from a delicate balance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption, which are both tightly regulated through maturation and subsequent activation of osteoblast and osteoclast precursors. A decrease in circulating estrogen levels due to menopause or endocrine therapy leads to a rapid loss of bone mineral density and an increase in fracture risk, implicating estrogen in the regulation of bone formation. The estrogen signaling pathway is also thought to have substantial cross-talk with the HER2 receptor pathway. Preclinical data demonstrate that upregulation of HER2 might contribute to resistance to endocrine therapy in hormone receptor–positive breast cancer cells, suggesting that coadministration of endocrine therapy with HER2-targeted therapy might circumvent this resistance mechanism. Ongoing studies are examining this dual-inhibition strategy as well as strategies to prevent bone loss 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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©Copyright 2009 by Physicians’ Education Resource. No material may be reproduced in whole or in part, in any form, without written permission from the publisher.

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Editor, Cancer Summaries & Commentaries
Physicians’ Education Resource
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Suite 700
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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. Novartis Oncology