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Dennis J. Slamon, MD, PhD
Chief, Division of Hematology-Oncology
Professor and Executive Vice Chair, Department of Medicine
Director for Clinical Research
Jonsson Comprehensive Cancer Center
Director, Revlon/UCLA Women's Health Research and Cancer Research Programs
University of California at Los Angeles School of Medicine
Los Angeles, CA
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Lisa A. Carey, MD
Medical Director, UNC Breast Center
University of North Carolina
Lineberger Comprehensive Cancer Center
Chapel Hill, NC
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CME-Accredited Webcasts, Presentation and Audio Downloads, and i-Tunes Podcast Downloads
11 didactic presentations, 3 panel discussions, 3 case studies, and 4 Point-Counterpoint debates from the live course
Third Annual Symposium on Personalized Therapies and Best Clinical Practices for Breast Cancer
held in La Jolla, CA on February 6, 2010
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You may participate in any or all of the sessions for CME credit or a Certificate of Attendance after you review the required ACCME (Accreditation Council on Continuing Medical Education) information on this page.
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Menu
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Overview of This CME-Accredited Educational Activity
Your Options for Methods of Participation are:
- View and/or listen to any of the sessions (listed below) via an Adobe Flash Webcast
- Download any slides as Adobe Acrobat files
- Download any audio only as MP3s or Podcasts
- Request a DVD-ROM of all sessions
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Sessions can be individually reviewed for credit. You can participate in as few or as many as you desire.
CME-Accredited Educational Activity Dates and Time to Complete
Date of release: May 24, 2010
Date expires (CME credit will not be avaliable): May 24, 2011
Average time to complete each individual session: 20 minutes
Time to complete entire activity: 8 hours
Overview
The OLC has conducted a very extensive physician practice gap analysis and needs assessment. As a result, we have determined that this activity is needed. The primary objective of the Personalized Therapies and Best Clinical Practices for Breast Cancer activity is to provide oncologists with the knowledge and competence enabling them to develop subsequent practice performance changes so that they can treat their patients with thoracic malignancies with the optimal personalized approaches in order to improve patient outcomes and minimize drug-induced toxicities. This CME activity is especially designed to help oncologists close several very important gaps in their practices arising primarily from the significant practice-changing data on breast cancer presented at the recent 2009 annual ASCO meeting and the 2009 SABCS.
Before the symposium begins, a pre-activity educational assessment consisting of approximately six to ten patient care treatment-strategy questions with multiple-choice answers will be conducted to determine how you currently treat your patients with breast cancer in order to determine a baseline of current medical oncologists' practices.
Educational Needs Summary
Much of the important new scientific and clinical data with breast cancer includes clinical trials' results regarding newer molecular biomarkers and tests that are helping make easier the identification of and the improved treatment of breast cancer patient sub groups and personalized therapies to treat them. At the 2009 ASCO meeting there were several abstracts and sessions including new data on existing and newer biomarker tests that can further help identify HER2-positive breast cancer patient sub populations. This information is critical for managing breast cancer patients who either failed to respond or who have relapsed on current anti-HER2 therapies, especially with the emergence of new anti-HER2 therapies for treating relapsed patients or patients who failed to respond to initial anti-HER2 therapy.
ASCO 2009 also revealed data on the subjects of the existing and also new gene-based assays that help with the identification of hormone-receptor positive patients who might better respond to endocrine therapy and to chemotherapy. One abstract was actually designed to show correlation of test results with the National Comprehensive Cancer Network (NCCN) treatment guidelines. New data regarding BRCA1 and BRCA2 testing was also revealed at the 2009 ASCO meeting. The faculty indicated that this is important for developing systemic regimens using PARP inhibitors and also for identifying patient sub groups who may better benefit from platinum-based therapies. And there were several abstracts and posters on the biomarker, SPARC (Secreted Protein acidic Rich in Cysteine) that were presented along with several clinical studies using nab-paclitaxel for breast cancer therapy in various treatment settings. Subsequently, there have been data regarding the clinical validation of a test that is a semi-automated assay that enables the capture, identification, and classification of circulating tumor cells, and the availability of a Breast Lymph Node (BLN) molecular diagnostic assay for breast lymph node testing, and further usage of both the commercially available 70-gene DNA micro array-based in vitro test, and the 21-gene assay which help determine therapy selection and disease recurrence in some patients.
And with this increasing number of diagnostic tests and molecular classification data and biomarkers, the following questions in practice have been addressed. "For which patients with breast cancer are these various tests including tests for HER2 status, most appropriate and useful?" "What are the appropriate clinical applications of gene-based testing?" What are the molecular predictors of response to adjuvant endocrine therapy?" And most importantly, "How does each of these tests help oncologists with improved decision making as they decide how to treat their patients with breast cancer? Thus, this entire area of using molecular biomarkers and testing is a major practice gap.
There still exists a practice gap between the IDEAL and BASELINE practices for personalizing radiation and surgical therapies for local-regional control of breast cancer. The primary goal of neoadjuvant therapy is the conversion of inoperable disease to operable disease. There is also potential to downstage involved axillary nodes and reduce axillary surgery. Reducing the need for radiation therapy is another potential outcome of effective neoadjuvant therapy. Long-term benefits with increase local-regional control of the disease through neo-adjuvant therapy and radiation may result in better long-term outcome. The personalized use of neo-adjuvant therapy is evolving and therefore there is a need to educate physicians on this topic to improve their practices.
And because of the new clinical data presented at the 2009 ASCO meeting on the three major sub types of breast cancer, HER2-positive, ER/PR-positive, and Triple Negative Disease (TND), both therapy for the first-line and for refractory patients wil be addressed, as well as therapy in the adjuvant setting.
This symposium will address a large amount of data on existing as well as investigational new drugs such as the increasing number of anti-HER2 therapies, dual anti-HER2 and anti-angiogenic inhibition, new targets such as PARP inhibition, newer monoclonal antibodies and other intracellular pathways and targets for breast cancer. And as previously mentioned, highlights from the annual San Antonio Breast Cancer Symposium in December 2009 which are important to clinicians will be included on February 6, 2010 in this Third Annual Symposium on Personalized Therapies and Best Clinical Practices for Breast Cancer.
The following is list of all sessions
Session 1: Diagnosis and Molecular Clasification of Breast Cancer for Personalizing Therapies
Chair: Peter M. Ravdin, PhD, MD |
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Prognostic Profiling: In which patients with breast cancer are these gene expression arrays beneficial? What are the clinical applications of gene testing for breast cancer?
Lisa A. Carey, MD
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Predictive Profiling: In which patients with breast cancer are these gene expression arrays beneficial? What are the clinical applications of gene testing for breast cancer? What are the molecular predictors of response to adjuvant endocrine therapy?
Matthew J. C. Ellis, MB, BChir, PhD
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Point-Counterpoint #1: Genomic profiling assay tests should be done for clinical decision making for node-positive breast cancer.
Yes: Lajos Pusztai, MD, DPhil
No: Lisa A. Carey, MD
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| 1d. |
How do the molecular tests we use help us with clinical decision making for treating our patients with breast cancer?
Peter M. Ravdin, PhD, MD
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Session 1 Case Study
Lajos Pusztai, MD, DPhil
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Panel Discussion, Q & A and Consensus on the Status of the Data Presented in this Session
Session 1 Faculty and Audience
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Session 2: Local-regional Control for Breast Cancer Patients
Chair: Lori J. Pierce, MD
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2a. |
Personalizing surgical therapy and best clinical for breast cancer patients
Kelly K. Hunt, MD, FACS |
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Personalizing radiation therapy and best clinical practices for breast cancer patients
Lori J. Pierce, MD |
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Session 2 Case Study
Kelly K. Hunt, MD, FACS |
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Panel Discussion, Q & A and Consensus on the Status of the Data Presented in this Session
Session 2 Faculty and Audience |
Session 3: Current Clinical Applications of Personalized Therapies and Best Clinical Practices for the
Three Major Sub-Types of Breast Cancer in both the Adjuvant and metastatic settings
Chair: Mark Pegram, MD |
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3a. |
Point-Counterpoint #2: Based upon the RIBBON One and Two trials' data bevacizumab should be included in any first-line therapy regimen with chemotherapy.
Yes: George W. Sledge, Jr.,MD
No: Clifford A. Hudis, MD
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3b. |
HER2-positive disease - Personalizing therapies with best clinical practices. State-of-the-Art Therapies.
Dennis J. Slamon, MD, PhD |
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3c. |
HER2-resistant breast cancer - How do we best manage these patients? Do we use different tests? Do we use different systemic therapies?
Mark Pegram, MD |
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3d. |
Point-Counterpoint #3: Adjuvant trastuzumab should be administered to patients with stage I breast cancers that are small, node-negative tumors.
Yes: Ana M. Gonzalez-Angulo, MD, MSc, FACP
No: Lisa A. Carey, MD |
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ER/PR-positive disease - Personalizing therapies with best clinical practices for adjuvant therapy, primary therapy and for resistant disease.
C. Kent Osborne, MD |
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Triple-negative-resistant breast cancer - How do we best manage these patients? Do we use different tests? Do we use different systemic therapies?
Judy E. Garber, MD, MPH |
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Point-Counterpoint #4: All high-risk patients with breast cancer should receive anthracycline therapy.
Yes: Harold J. Burstein, MD, PhD
No: Dennis J. Slamon, MD, PhD |
Session 4: New Developments and Investigational Drugs for Treating Patients With Breast Cancer
Chair: Allan Lipton, MD |
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4a. |
Investigational drugs treating breast cancer patients (including
data from the San Antonio Breast Cancer Symposium)
Mark Pegram, MD |
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4b. |
From bone health to metastases: bone targeted agents in
breast cancer
Allan Lipton, MD
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4c. |
Case Study
Mark Pegram, MD |
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4d. |
Panel Discussion, Q & A and Consensus on the Status of the Data Presented in this Session
Session 3 and 4 Faculty and Audience |
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Educational Objectives
At the conclusion of all of these enduring materials, you should be able to:
- Compare and contrast the new scientific and clinical data of the various molecular biomarkers and tests for HER2 status and hormonal status, regarding their roles and value for the selection of treatments for patients with breast cancer and for their prognosis.
- Devise strategies to apply the predictive and prognostic molecular biomarkers and tests in the clinic in order to help develop more personalized and optimal treatment regimens for patients with breast cancer.
- Determine the best clinical practices for the roles of radiation and surgery for local-regional control of breast cancer patients.
- Devise strategies for more personalized approaches for treating each of the three major subtypes of breast cancer, HER2-positive, ER/PR-positive, and Triple-Negative Disease.
- Evaluate the options for the treatment for patients who have either failed to respond to initial therapy or who have relapsed, for each of the three major subtypes of breast cancer: HER2-positive, ER/PR-positive and Triple-Negative Disease.
- Compare and contrast the different options for treating bone metastases and for maintaining bone health in patients with breast cancer including bisphosphonates and inhibitors of RANK Ligand.
- Evaluate the clinical applications of the investigational drugs in late-stage development and available for enrolling breast cancer patients in clinical trials.
- Evaluate the latest clinical data supporting the use of a bisphosphonate for the adjuvant therapy of early-stage, pre-menopausal breast cancer patients and determine how to best apply this in the clinic.
Target Audience
This activity is designed to meet the educational needs of medical oncologists, hematologist/oncologists, radiation oncologists, surgical oncologists, pathologists, physician assistants, nurse practitioners/nurses, pharmacists, fellows and other health care professionals who are involved in the treatment or management of breast cancer patients. Breast cancer is treated optimally by a multi-disciplinary approach of clinicians and, thus, all of the aforementioned clinician specialties are targeted for invitation.
CME Accreditation & Credit Designation
The Oncology Learning Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Oncology Learning Center designates this educational activity for a maximum of 8 AMA PRA Category 1
Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
CME Certificate or Certificate of Participation
The relevant section(s) of the Evaluation Form pertaining to the session(s) of the enduring materials you have viewed or listened to, and the Request for Credit Form must be completed and submitted to the Oncology Learning Center following your participation in the enduring material educational activity to obtain CME credit. Physicians and other participants will be able to print their certificates after they complete these Forms.
Disclosure of Conflicts of Interest
In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, educational programs sponsored by the Oncology Learning Center must demonstrate balance, independence, objectivity, and scientific rigor. All faculty, authors, editors, and planning committee members participating in an OLC-sponsored activity are required to disclose any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services that are discussed in an educational activity. |
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Faculty Disclosures
It is the policy of the Oncology Learning Center, Inc. (OLC) to ensure that all of its educational activities and materials are of the highest quality, and are balanced, objective, independent, free of commercial bias, and planned and developed with scientific rigor with strict adherence to all Accreditation Council for Continuing Medical Education (ACCME) rules and policies. The OLC evaluates all content, faculty and faculty disclosures for any potential conflicts of interest. Should any conflicts of interest be identified these conflicts are resolved in advance of the educational activity by independent peer reviewers who are experts in the subjects of the educational activity.
All faculty and OLC staff participating in the content, planning or implementation of an educational CME activity are required to disclose to the audience of the educational activity any relevant financial relationships or interests and to assist in the resolution of any conflict of interest that may arise from the relationship(s) or interest(s). It is also the policy of the OLC to require all faculty presenters to make a meaningful disclosure to the audience of their discussions of unlabeled or FDA unapproved drugs, products, tests or devices. This information will be available as part of the educational activity and related material.
The following faculty and OLC staff have reported real or potential relevant conflicts of interest and these conflicts have been resolved, prior to this educational activity through a peer-review process by two medical oncologists who have had no affiliation with this educational activity other than the peer review process. This is documented on this page immediately following the financial disclosures below.
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Harold J. Burstein, MD, PhD
I have no real or apparent conflicts of interest to report.
Lisa A. Carey, MD
I have no real or apparent conflicts of interest to report.
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation
Matthew J. C. Ellis, MB, BChir, PhD
Consultant: Novartis, AstraZeneca, Pfizer, Merck, GSK, Genentech, Monogram Biosciences, Qiagen GmbH
Fees for Non-CME Services Received Directly from Commercial Interest: Novartis, AstraZeneca, Pfizer, GSK, Genentech
Contracted Research: Novartis, AstraZeneca, Taiho, GSK
Roy S. Herbst, MD, PhD
Consultant: Genentech, Bristol-Myers Squibb, Amgen, OSI, AstraZeneca, Eli Lilly
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation.
Judy E. Garber, MD, MPH
Consultant: Generation Health
Funded Research: AstraZeneca, Abbott
Ana M. Gonzalez-Angulo, MD, MSc, FACP
I have no real or apparent conflicts of interest to report.
Clifford A. Hudis, MD
Contracted Research: Onyx Pharmaceuticals, Merck
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation.
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Kelly K. Hunt, MD, FACS
Fees for Non-CME Services Received Directly from Commercial Interest: Novartis
Allan Lipton, MD
Consultant: Amgen, Novartis
Fees for Non-CME Services Received Directly from Commercial Interest: Amgen, Novartis
Contracted Research: Novartis
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation
C. Kent Osborne, MD
Consultant: Novartis, GSK, Onyx, Pfizer, AstraZeneca
Royalty: Lippincott (editor of text books)
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation
Mark Pegram, MD
Consultant: Genentech, GSK, Sanofi-Aventis
Fees for Non-CME Services Received Directly from Commercial Interest: Genentech, GSK, AstraZeneca
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation.
Lori J. Pierce, MD
I have no real or apparent conflicts of interest to report.
Lajos Pusztai, MD, DPhil
Consultant: BMS
Ownership Interest: Nuvera Biosciences
Peter M. Ravdin, PhD, MD
Ownership Interest: Adjuvant Inc.
Dennis J. Slamon, MD, PhD
Consultant: AstraZeneca, Genentech, GSK, Novartis, Pfizer, Roche, Sanfi-Aventis
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation.
George W. Sledge, Jr., MD
I have no real or apparent conflicts of interest to report.
Oncology Learning Center staff
We have no real or apparent conflicts of interest to report.
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Faculty Affiliations
Dennis J. Slamon, MD, PhD (Co-Chair)
Chief, Division of Hematology-Oncology
Professor and Executive Vice Chair,
Department of Medicine
Director for Clinical Research,
Johnson Comprehensive Cancer Center
Director, Revlon/UCLA Women's Health Research
and Cancer Research Programs
University of California at Los Angeles
School of Medicine
Los Angeles, California
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Allan Lipton, MD
Professor of Medicine and Oncology
M. S. Hershey Medical Center
The Pennsylvania State University
Hershey, PA
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Lisa A. Carey, MD (Co-Chair)
Medical Director
UNC Breast Center
University of North Carolina
Lineberger Comprehensive Cancer Center
Chapel Hill, NC
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C. Kent Osborne, MD
Director, Breast Center at Baylor College
of Medicine
Director, Baylor Cancer Center
Professor of Medicine and Cellular
and Structural Biology
Baylor Cancer Center
Houston, TX
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Harold J. Burstein, MD, PhD
Professor of Medicine
Harvard Medical School
Dana-Farber Cancer Institute
Boston, MA
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Mark Pegram, MD
Professor of Medicine and Oncology
Director, Breast Cancer Program
University of Miami Cancer Center
Miami, FL
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Matthew J. C. Ellis, MB, BChir, PhD
Professor, Department of Medicine
Oncology Division
Medical Oncology Section
Washington University School of Medicine
St. Louis, MO
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Lori J. Pierce, MD
Vice Provost for Academic and Faculty Affairs
Professor, Department of Radiation Oncology
University of Michigan
Ann Arbor MI
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Judy E. Garber, MD, MPH
Director, Cancer Risk and Prevention Program
Associate Professor of Medicine,
Harvard Medical School
Dana-Farber Cancer Institute
Boston, MA
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Lajos Pusztai, MD, DPhil
Professor of Medicine
Department of Breast Medical Oncology
The University of Texas
M. D. Anderson Cancer Center
Houston, TX
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Ana M. Gonzalez-Angulo, MD, MSc, FACP
Assistant Professor,
Department of Breast Medical Oncology
Assistant Professor,
Department of Systems Biology
Division of Cancer Medicine
The University of Texas
M. D. Anderson Cancer Center
Houston, TX
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Peter M. Ravdin, PhD, MD
Adjunct Professor of Medical Oncology
University of Texas at San Antonio
San Antonio, TX
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Clifford A. Hudis, MD
Chief, Breast Cancer Medicine Service
Memorial Sloan-Kettering Cancer Center
New York, NY
Co-Chair, Breast Committee,
The Cancer and Leukemia Group B (CALGB)
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George W. Sledge, Jr., MD
Ballvé-Lantero Professor of Oncology and Pathology
Co-Director, Breast Cancer Program
Indiana University Cancer Center
Indianapolis, IN
Co-Chair, Breast Committee,
The Eastern Oncology Cooperative Group (ECOG)
President, American Society of Clinical Oncology
(ASCO)
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Kelly K. Hunt, MD, FACS
Professor of Surgery
Chief, Surgical Breast Section
Department of Surgical Oncology
The University of Texas
M. D. Anderson Cancer Center
Houston, TX
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Peer Review Process of Conflicts of Interest
This educational activity has been independently peer-reviewed.
Disclosure of Unlabeled Uses
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration (FDA). For additional information about approved uses, including approved indications, contraindications, and warnings, please refer to the prescribing information for each product or consult the Physicians' Desk Reference.
The Oncology Learning Center (OLC) does not recommend the use of any agent outside of the FDA labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the OLC. Please refer to the official FDA prescribing information for each product for discussion of approved indicated, contraindications, and warnings.
Acknowledgement of Supporters
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