TARGET AUDIENCE
This activity has been designed to meet the educational needs of oncology nurses, nurse practitioners and clinical nurse specialists involved in the treatment of breast cancer (BC).

OVERVIEW OF ACTIVITY
BC remains the most frequently diagnosed cancer in women, and in 2019 in the United States alone the disease will culminate in an estimated 271,270 new cases and 42,260 deaths. The current clinical management of BC is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indication and/or utility of these local and systemic treatment options is largely based on a number of prognostic and predictive risk factors present within the patient or tumor at the time of diagnosis. In fact, as the field of oncology is challenged to improve the precision with which it therapeutically targets malignant cells, biomarker-driven treatment algorithms have become the “norm” for many tumor types, particularly BC. Increasingly, an emphasis is being placed on a “personalized medicine” approach that promises to more effectively identify specific treatments that will benefit individuals based on specific patient- and disease-related characteristics. In conjunction with this approach researchers are actively attempting to develop novel agents and immunotherapeutic strategies, with the aim of generating additional benefit, enhancing the efficacy of existing treatments or overcoming resistance to endocrine therapy, chemotherapy or biologic therapy. As such, the pace of change in the field of breast medical oncology has been rapid, and it is expected that a plethora of new data will continuously be disseminated requiring ongoing efforts to keep medical professionals informed.

Although medical oncologists have been routinely responsible for counseling patients with regard to therapeutic decision-making, oncology nurses play an integral role in the successful delivery of systemic anticancer therapy and the preservation of patient physical and psychosocial well-being. These video proceedings from the fifth part of a 6-part integrated CNE curriculum originally held at the 2019 ONS Annual Congress feature discussions with leading BC investigators and their nursing counterparts regarding actual patient cases and recent clinical research findings affecting the optimal therapeutic and supportive care for each patient scenario.

PURPOSE STATEMENT
By providing information on the latest research developments in the context of expert perspectives, this CNE activity will assist oncology nurses, nurse practitioners and clinical nurse specialists with the formulation of state-of-the-art clinical management strategies to facilitate optimal care of patients with BC.

LEARNING OBJECTIVES

• Apply existing and emerging research data to the diagnostic, therapeutic and supportive care of patients with early and advanced BC.
• Implement a long-term clinical plan for the management of early and advanced HER2-positive BC, incorporating existing and investigational targeted treatments.
• Recognize the FDA-endorsed indications for the commercially available CDK4/6 inhibitors, and discern how these agents can be optimally employed in the nonresearch care of patients with ER-positive metastatic BC (mBC).
• Develop an understanding of the frequency and potential biologic implications of PIK3CA mutations in patients with ER-positive mBC previously treated with endocrine therapy, and appreciate published research data documenting the efficacy and safety of novel agents targeting this abnormality.
• Develop a plan to manage the side effects associated with available and recently approved systemic therapies to support quality of life and continuation of treatment.
• Appreciate the biologic rationale for and available data with novel immunotherapeutic approaches to facilitate their introduction into clinical practice for appropriate patients with mBC.

ACCREDITATION STATEMENT
Research To Practice (RTP) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

CREDIT DESIGNATION STATEMENT
CNE credit is no longer available for this issue

ONCC/ILNA CERTIFICATION INFORMATION
CNE credit is no longer available for this issue

FOR SUCCESSFUL COMPLETION
This is a video CNE program.
CNE credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES
RTP is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CNE activities. Conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

Erika Hamilton, MD
Director, Breast and Gynecologic Research Program
Sarah Cannon Research Institute
Nashville, Tennessee

No relevant conflicts of interest to disclose.

Elizabeth O’Reilly, RN, NP, MSN, MPH
Nurse Practitioner, Breast Oncology
Susan F Smith Center for Women’s Cancers
Dana-Farber Cancer Institute
Boston, Massachusetts

No relevant conflicts of interest to disclose.

Hope S Rugo, MD
Professor of Medicine
Director, Breast Oncology and Clinical Trials Education
University of California, San Francisco Medical Center
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California

Contracted Research: Daiichi Sankyo Inc, Eisai Inc, Genentech, Lilly, MacroGenics Inc, Merck, Novartis, OBI Pharma Inc, Odonate Therapeutics, Pfizer Inc, Seattle Genetics; Paid Travel: Amgen Inc, Lilly, Merck, Mylan, Pfizer Inc, Puma Biotechnology Inc.

Gretchen Santos, RN, MSN, FNP-BC
University of California, San Francisco Medical Center
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California

No financial interests or affiliations to disclose.

MODERATOR — Dr Love is president and CEO of Research To Practice. Research To Practice receives funds in the form of educational grants to develop CME/CNE activities from the following commercial interests: AbbVie Inc, Acerta Pharma — A member of the AstraZeneca Group, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech, Genmab, Genomic Health Inc, Gilead Sciences Inc, Guardant Health, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Loxo Oncology Inc, a wholly owned subsidiary of Eli Lilly & Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, Natera Inc, Novartis, Oncopeptides, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sandoz Inc, a Novartis Division, Sanofi Genzyme, Seattle Genetics, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro, Teva Oncology, Tokai Pharmaceuticals Inc and Tolero Pharmaceuticals.

RTP CNE PLANNING COMMITTEE MEMBERS, STAFF AND REVIEWERS — Planners, scientific staff and independent reviewers for RTP have no relevant conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Genentech, Lilly, Merck, Novartis and Puma Biotechnology Inc.

Hardware/Software Requirements:
A high-speed Internet connection
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
Adobe Flash Player 27 plug-in or later
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio

Release date: June 2019
Expiration date: June 2020

There is no implied or real endorsement of any product by RTP or the American Nurses Credentialing Center.