Case 2: A 71-Year-Old White Female with HER2-Positive Metastatic Breast Cancer

Program Description:

This case takes a detailed look at a 71-year-old white female who had been previously diagnosed with a stage-2 invasive hormone-receptor (HR) negative, HER2-positive ductal carcinoma along with 4 of 9 axillary lymph nodes involved with metastatic disease. The patient was treated with docetaxel, carboplatin, and trastuzumab, a monoclonal antibody that interferes with the HER2/neu receptor.

The principal clinical decision for this patient was the selection of systemic therapy for documented metastatic HER2-positive breast cancer. As she had multiple areas of disease involving the ribs and spine, the discussion centered on the use of the RANK ligand inhibitor, denosumab, which provided assistance in delaying or preventing this woman’s skeletal-related events. This case study also reviewed in great detail alternative systemic therapies to treat her metastatic HER2-positive cancer, including the National Comprehensive Cancer Network-recommended monoclonal pertuzumab plus trastuzumab in combination with a taxane as first-line treatment, as well as other HER2-targeted agents, such as the tyrosine kinase inhibitor lapatinib.

INTENDED AUDIENCE:

Oncologists, thoracic surgeons, pathologists, internists, ob/gyns, and other clinicians who treat or manage women with breast cancer.

Activity Objectives:

After taking part in this educational activity, participants should be better able to:

• Identify protocols among patients with HER2+ locally advanced or metastatic breast cancer who are inadequately responsive to established treatments


• Evaluate the efficacy and safety of target-specific monoclonal antibodies and an experimental antibody-drug conjugate for patients with HER2+ locally advanced or metastatic breast cancer

Faculty:

William J. Gradishar, M.D., FACP
Betsy Bramsen Professor of Breast Oncology
Professor of Medicine
Director, Maggie Daley Center for Women's Cancer Care
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine
Northwestern Memorial Hospital
Chicago, IL

Disclosures:

To resolve identified conflicts of interest, the educational content was fully reviewed by Hemedicus Inc. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

Faculty Disclosures
As an ACCME-accredited provider of continuing medical education, Hemedicus Inc., requires that faculty participating in a CME activity disclose any relevant financial relationship they may have with a pharmaceutical or medical-equipment company, product, or service within the preceding 12 months, including any relationship with the commercial supporter of this activity. The faculty reported the following:

Dr. Gradishar has no real or apparent conflicts of interest to report.

Review Committee Disclosure
In accordance with the Accreditation Council for Continuing Medical Education (ACCME), Hemedicus, Inc., requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Accordingly the staff of Hemedicus Inc., as planners and reviewers, disclose as follows:

Hemedicus Inc.
Jonathan Wood: No relevant financial relationships with any commercial interest.
Robin Simak: No relevant financial relationships with any commercial interest.
Erilyn Riley: No relevant financial relationships with any commercial interest.

Haymarket Medical Education
Lynne Callea: No relevant financial relationships with any commercial interest.
Nick Zittell: No relevant financial relationships with any commercial interest.
Debra Hughes: No relevant financial relationships with any commercial interest.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in this educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Furthermore, participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Disclaimer
The content and views presented in this educational activity are those of the presenters and do not necessarily reflect those of Hemedicus Inc., or the supporter. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

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Accredited Provider:

This activity is accredited by Hemedicus, Inc.



Produced by

Commercial Supporter:

There is no commercial support for this educational activity.

Instructions:

To obtain credit, a score of 70% or better is required. This CME is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the posttest survey, and have received your digital copy of your credit certificate. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.

If you have any questions relating to your certificate or technical issues with this activity, please contact myCME.Support@haymarketmedical.com.

If you have any questions relating to the accreditation of this activity, please contact Robin Simak, Managing Director, CME Compliance, Hemedicus Inc., rsimak@hemedicus.com.

SYSTEM REQUIREMENTS:

WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH^® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.