Breast Cancer CME ACCREDITED Watch Time: 33 mins

touchPANEL DISCUSSION Expanding options for HER2 advanced breast cancer: Taking trial data to the clinic

Three experts discuss emerging treatments for HER2-directed therapies for advanced breast cancer and the implications for clinical practice

Dr Laura Biganzoli

Oncology Department, Hospital of Prato, Prato, Italy

CHAIR

Panelists:
Dr Peter Fasching, Dr Sonia Pernas
 
Video Chapters
Introduction

Dr Laura Biganzoli welcomes the expert panel and introduces the discussions covering expanding treatment options for HER2 breast cancer

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1/4 Next Chapter
 
Progress with HER2-targeted therapies in advanced breast cancer

The panel discusses recent key data for trastuzumab deruxtecan, tucatinib and margetuximab from clinical trials in HER2+ breast cancer

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2/4 Next Chapter
 
Maintaining HER2-targeted therapies: How to manage adverse events

The expert panel considers key adverse events for emerging agents in HER2-positive breast cancer and strategies for managing them

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3/4 Next Chapter
 
Novel HER2-directed approaches: Implications for future practice

The expert panel discusses novel approaches for addressing key challenges in the management of HER2-positive breast cancer

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Overview & Learning Objectives
Overview

In this activity, experts in breast cancer discuss the efficacy of emerging HER2-targeted therapies for advanced breast cancer and consider mitigation strategies for key adverse events. They conclude with a review of other novel HER2-directed treatments.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists, breast cancer specialists, nurse specialists involved in the management of advanced breast cancer.

Disclosures

All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Laura Biganzoli discloses: Advisory board/panel discussion fees from AstraZeneca, Daiichi Sankyo, Eisai, Novartis, Pfizer, Pierre Fabre; consultancy fees from AstraZeneca, Daiichi Sankyo, Eisai, Eli Lilly, Novartis, Pfizer and Pierre Fabre; grant/research support from Celgene, Genomic Health and Novartis.

Dr Peter Fasching discloses: Advisory board/panel discussion fees from Agendia, AstraZeneca, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche, Sandoz, Sanofi Aventis and SeaGen; grant/research support from Biotech and Cephid.

Dr Sonia Pernas discloses: Advisory board/panel discussion fees from AstraZeneca, Daiichi Sankyo, Eisai, Pierre Fabre, Polyphor, Roche and SeaGen.

Content Reviewer

Kaitlin Hendrix, ARNPAdvisory Board – Sanofi-Genzyme, Daiichi-Sankyo, and Novartis (All relationships terminated)

Touch Medical Director

Alison Scott has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Accreditations
Physician

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

ILNA

The program content has been reviewed by the Oncology Nursing Certification Corporation (ONCC) and is acceptable for recertification points.

Disclaimer: ONCC review is only for designating content to be used for ILNA points and is not for NCPD accreditation. NCPD programs must be formally approved for contact hours by an acceptable accreditator/approver of nursing NCPD to be used for recertification by ONCC. If the NCPD provider fails to obtain formal approval to award contact hours by an acceptable accrediting/approval body, no information related to ONCC recertification or ILNA categories may be used in relation to the program.

Date of original release: 11 November 2021. Date credits expire: 11 November 2022.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Evaluate the latest efficacy data for different HER2-targeted therapies in advanced breast cancer
  • Apply appropriate monitoring for and management of adverse events in patients receiving HER2-targeted therapies
  • Describe how novel approaches to HER2-targeting for advanced breast cancer in development may impact clinical practice
Faculty & Disclosures
Dr Laura Biganzoli

Oncology Department, Hospital of Prato, Prato, Italy

Laura Biganzoli is the Acting Director for the Medical Oncology Unit and Director of the Breast Center in the Oncology Department of the Hospital of Prato in Italy.
Dr Biganzoli’s research focuses on breast cancer and geriatric oncology, and she has extensively lectured and published in these fields. read more

Dr Biganzoli is a representative of the European Society for Medical Oncology/International Society of Geriatric Oncology (ESMO/SIOG) Cancer in Elderly Working Group, chair of the Science and Education committee of SIOG, and Board member of the Gruppo Italiano di Oncologia Geriatrica (GIOGer). She is also a member of a committee engaged in writing national guidelines for the Associazione Italiana di Oncologia Medica (AIOM) and a member of the Advanced Breast Cancer (ABC) Consensus Panel.

Dr Laura Biganzoli discloses: Advisory board/panel discussion fees from AstraZeneca, Daiichi Sankyo, Eisai, Novartis, Pfizer, Pierre Fabre; consultancy fees from AstraZeneca, Daiichi Sankyo, Eisai, Eli Lilly, Novartis, Pfizer and Pierre Fabre; grant/research support from Celgene, Genomic Health and Novartis.

Dr Peter Fasching

University Hospital Erlangen and Comprehensive Cancer Center, Erlangen-EMN, Erlangen, Germany

Dr Peter Fasching is Associate Professor of Gynecology and Obstetrics at the Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany. read more

Dr Fasching holds a professorship in translational medicine. He is interested in the discovery and translation of novel therapeutic targets in cancer treatment, with a current focus on cancers in women. He specializes in the individualization of cancer therapies, including the personalization of breast cancer prevention, and the integration of molecular and imaging characteristics into screening for breast cancer. He is also interested in the discovery of novel molecular targets for breast cancer prevention drugs that possess more favourable benefit–risk profiles. More recently, a substantial part of his work has included big data and machine learning to support novel drug target discovery.

Dr Fasching has co-authored more than 630 peer-reviewed research articles, and his research is funded by the National Institutes for Health (NIH) (USA), the European Union, the German Ministry for Health, the German Ministry for Economy and the German Ministry for Education and Research. He is a member of several societies including the American Society of Clinical Oncology, the German Society for Breast Diseases and the European Society for Medical Oncology.

Dr Peter Fasching discloses: Advisory board/panel discussion fees from Agendia, AstraZeneca, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche, Sandoz, Sanofi Aventis and SeaGen; grant/research support from Biotech and Cephid.

Dr Sonia Pernas

Catalan Institute of Oncology, and Faculty of Medicine, University of Barcelona, Barcelona, Spain

Dr Sonia Pernas is an oncologist with extensive clinical expertise in breast cancer and interest in clinical and translational research. read more

Dr Pernas’ primary research interest is in HER2-positive breast cancer and gene expression. Other areas of interest include biomarkers of response/resistance to therapy, identification of novel actionable target genes and their use to support rational sequencing strategies.

Dr Pernas has extensive clinical research experience, having been involved, both as principal investigator (PI) and co-PI, in many phase 1 to 4 clinical and window-of-opportunity trials in breast cancer. She has also collaborated in multiple translational research projects with national and international institutions.

Dr Pernas serves as a Board Member of the Spanish academic research group in oncology, SOLTI.

Dr Sonia Pernas discloses: Advisory board/panel discussion fees from AstraZeneca, Daiichi Sankyo, Eisai, Pierre Fabre, Polyphor, Roche and SeaGen.

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Question 1/5
In the DESTINY-Breast03 trial reported at ESMO 2021, how did trastuzumab deruxtecan compare with trastuzumab emtansine in patients with HER2+ ABC previously treated with trastuzumab and taxane?

ABC, advanced breast cancer; ESMO, European Society for Medical Oncology, HER2+, human epidermal growth factor receptor 2-positive.
Correct

In data presented at ESMO 2021 from the DESTINY-Breast03 trial, trastuzumab deruxtecan demonstrated a highly statistically significant and clinically meaningful improvement in progression-free survival compared with trastuzumab emtansine (HR 0.284; p=7.8 x 10–22) and had a manageable toxicity profile.

Abbreviations
HR, hazard ratio.

Reference
Cortés J, et al. Ann Oncol. 2021;32(Suppl. 5):S1283–346.

Question 2/5
Your patient is a 40-year-old woman with HER2+ ABC that has metastasized to her brain. Based on recent data for emerging agents in patients with HER2+ ABC, which emerging treatment regimen might be most suitable for your patient with active brain metastases?

ABC, advanced breast cancer; HER2+, human epidermal growth factor receptor 2-positive.
Correct

The HER2CLIMB study investigating tucatinib + trastuzumab + capecitabine reported improved median overall survival in patients with HER2+ ABC and active brain metastases compared with placebo + trastuzumab + capecitabine (HR 0.60; 95% CI 0.44–0.81).1 The DESTINY-Breast03 trial of trastuzumab deruxtecan versus trastuzumab emtansine2,3 and the SOPHIA trial of margetuximab + chemotherapy4 both permitted the inclusion of patients with prior brain metastases, if treated and stable, but explicitly excluded patients with active brain metastases.

Abbreviations
ABC, advanced breast cancer; CI, confidence interval; HER2+, human epidermal growth factor receptor 2-positive; HR, hazard ratio.

References

  1. Curigliano G, et al. J Clin Oncol. 2021;39(Suppl. 15):1403.
  2. ClinicalTrials.gov. NCT02614794, Available at: https://clinicaltrials.gov/ct2/show/NCT03529110 (accessed 19 October 2021.
  3. Cortés J, et al. Ann Oncol. 2021;32(Suppl. 5):S1283–346.
  4. Rugo H, et al. JAMA Oncol. 2021;7:573–84.
Question 3/5
You decide to prescribe tucatinib for your patient with HER2+ ABC. Which strategy do you use to mitigate potential AEs?

ABC, advanced breast cancer; AEs, adverse events; HER2+, human epidermal growth factor receptor 2-positive.
Correct

Severe hepatotoxicity has been reported for tucatinib, so ALT, AST and bilirubin levels should be measured before starting treatment and then monitored every three weeks, and as clinically indicated. Hepatotoxicity should be managed by dose interruption or reduction, permanently discontinuing treatment if necessary.1,2

Abbreviations
ALT, alanine aminotransferase; AST, aspartate aminotransferase.

References

  1. Tucatinib. Highlights of prescribing information. 2020. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2020/213411s000lbl.pdf (accessed 14 October 2021).
  2. Tucatinib. Summary of product characteristics. 2021. Available at: www.ema.europa.eu/en/documents/product-information/tukysa-epar-product-information_en.pdf (accessed 14 October 2021).
Question 4/5
Which of the following is a suitable management strategy for diarrhoea in patients receiving HER2-targeted therapies?

HER2, human epidermal growth factor receptor 2.
Correct

For uncomplicated diarrhoea with targeted agents, oral hydration with dietary modification and antidiarrhoeal medication is recommended. For more persistent or severe diarrhoea, octreotide can be considered.

Reference
Bossi P, et al. Ann Oncol. 2018;29(Suppl. 4):iv126–42.

Question 5/5
Which CDK4/6 inhibitor is being investigated in HR+/HER2+ ABC in combination with trastuzumab and fulvestrant?

ABC, advanced breast cancer; CDK, cyclin dependent kinase; HER2+, human epidermal growth factor receptor 2-positive; HR+, hormone receptor-positive.
Correct

The monarcHER trial is investigating abemaciclib + trastuzumab + fulvestrant in patients with HR+/HER2+ ABC with ≥2 prior HER2-directed therapies and has reported improved median progression-free survival for this regimen compared with standard of care chemotherapy plus trastuzumab (8.3 months versus 5.7 months, respectively; HR 0.67).

Abbreviations
HR, hazard ratio.

Reference
Tolaney SM, et al. Lancet Oncol. 2020;21:763–75.

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