Continuing Medical Education Information
Hormonal Therapy: Current Status in the Treatment of Metastatic Breast Cancer
Activity Release Date: October 1, 2007
Activity Expiration Date: October 1, 2008
About the Activity
This activity is based on a brief article developed as part of the E-Update Series and posted on the Web. The series is geared to oncologists and addresses new treatments of cancer or modifications thereof.
This activity has been developed and approved under the direction of Beam Institute.
Activity Learning Objectives
After reading this article, participants should be able to:
- Understand the role of hormonal therapy in the treatment of metastatic breast cancer.
- Identify the mechanisms of action of hormonal agents for treating breast cancer.
- List types of patients likely to benefit from hormonal therapy.
- Know when to consider using hormonal agents and the sequence to follow.
- Summarize the historic and current use of tamoxifen to treat postmenopausal patients with metastatic breast cancer.
- Classify aromatase inhibitors into first-, second-, and third-generation agents and whether they are nonsteroidal/reversible or steroidal/reversible.
- List significant findings and understand the implications of key trials using aromatase inhibitors.
- Understand the role of fulvestrant as an additional treatment option for postmenopausal women with metastatic breast cancer.
- Know how fulvestrant compared to aromatase inhibitors and to tamoxifen in clinical trials.
- Identify the modalities used to achieve ovarian ablation and ovarian suppression and the advantages and disadvantages of each.
- List targeted agents being evaluated in combination with aromatase inhibitors.
Target Audience
This activity targets physicians in the fields of oncology and hematology.
Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Beam Institute and The Oncology Group. Beam Institute is accredited by the ACCME to provide continuing medical education for physicians.
Continuing Education Credit
AMA PRA Category 1 Credit™
The Beam Institute designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Compliance Statement
This activity is an independent educational activity under the direction of Beam Institute. The activity was planned and implemented in accordance with the Essential Areas and policies of the ACCME, the Ethical Opinions/Guidelines of the AMA, the FDA, the OIG, and the PhRMA Code on Interactions with Healthcare Professionals, thus assuring the highest degree of independence, fair balance, scientific rigor, and objectivity.
However, Beam Institute, the Grantor, and CMPMedica shall in no way be liable for the currency of information or for any errors, omissions, or inaccuracies in the activity. Discussions concerning drugs, dosages, and procedures may reflect the clinical experience of the author(s) or may be derived from the professional literature or other sources and may suggest uses that are investigational in nature and not approved labeling or indications. Activity participants are encouraged to refer to primary references or full prescribing information resources. The opinions and recommendations presented herein are those of the author(s) and do not necessarily reflect the views of the provider or producer.
Financial Disclosures
Dr. Dang is a consultant and a member of the speakers' bureau and has received research support from Genentech. Dr. Hudis is a member of the speakers' bureau for AstraZeneca and Genentech; he is also a member of the advisory boards of Amgen, Bristol-Myers Squibb, Novartis, Sanofi-Aventis, Pfizer, and Roche. Dr. Hudis has indicated ownership stock in Genomic Health. He has performed research for Kosan Biosciences.
Copyright
Copyrights owned by Beam Institute, a division of CME LLC. Copyright 2007, CME LLC. All rights reserved.
Contact Information
We would like to hear your comments regarding this or other activities provided by Beam Institute. In addition, suggestions for future activities are welcome. Contact us at:
Address:
Director of Continuing Education
Beam Institute
11 West 19th Street, 3rd Floor
New York, NY 10011-4280
Phone: 888-618-5781
Fax: 212-600-3050
e-mail: beaminstitute@cmp.com
Introduction
In general, metastatic breast cancer (MBC) is treated systemically using chemotherapy, hormonal therapy, and newer targeted therapies when appropriate. About 75% of breast cancers test positive for estrogen receptors (ER) and progesterone receptors (PR), and estrogen stimulation of these receptors plays an important role in the proliferation of these tumors.1
For patients with ER/PR-positive breast cancer, hormonal therapy is the preferred treatment if possible. For patients with rapidly progressive tumors or those in visceral crises, chemotherapy may be preferred because of its rapid rate of response, although even in this situation, hormonal therapy may be feasible.
Hormonal therapy is generally attractive because there are a variety of effective options available and the toxicities are generally mild. An important indicator of response is the presence of the ER and PR on the tumors2 and their quantitative levels.3 Following the observation by Sir Beatson over a century ago that oophorectomy in premenopausal women induced tumor regression,4 hormonal therapy has been extensively used in the treatment of patients with ER/PR-positive breast cancer. The mechanisms of action of hormonal agents include:
- blocking the interaction between estrogen and estrogen receptors with selective estrogen receptor modulators (SERM);
- degrading the estrogen receptors with selective estrogen receptor down-regulators (SERD); and
- inhibiting estrogen production with an aromatase inhibitor (AI) or with surgical, radiation, or chemical ovarian ablation in premenopausal patients.
This E-Update will focus on the hormonal treatment options for MBC.
