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    Faculty & Disclosures
    Prof. Peter Schmid

    St. Bartholomew’s Hospital, London, UK

    Prof. Peter Schmid, MD, PhD, FRCP, is the clinical director of the Breast Cancer Centre and an honorary consultant medical oncologist at St. Bartholomew’s Hospital in London, UK. read more

    He was appointed in 2013 as chair in cancer medicine at Barts Cancer Institute (BCI), Queen Mary University, London. Prof. Schmid is also lead of the Centre for Experimental Cancer Medicine at BCI, overseeing the conduct of early phase trials at St. Bartholomew’s Hospital and BCI, with a particular interest in immunotherapy, innovative trial designs, and circulating biomarkers. He leads the academic breast cancer programme at St. Bartholomew’s Hospital and BCI.

    Prof. Schmid’s primary research interest is in breast cancer. Specific research areas include cancer immunotherapy, triple-negative breast cancer, endocrine resistance, and innovative biomarker-driven trial concepts. He runs an international collaborative clinical and translational research programme. He is the principal investigator of several pivotal breast cancer studies, including the IMpassion130 trial. He is also the lead investigator of the KEYNOTE-522 trial. His work has been published in many journals including the New England Journal of Medicine, the Lancet, the Lancet Oncology, JAMA Oncology, Nature and the Journal of Clinical Oncology. 

    Prof. Schmid is a member of several national and international cancer organisations and research groups and has been involved in international consensus meetings on the management of breast cancer. Prof. Peter Schmid is a member of the European Society for Medical Oncology (ESMO) breast cancer faculty.

    Prof. Peter Schmid discloses: Advisory board or panel fees from AstraZeneca, Bayer, Boehringer Ingelheim, Celgene, Eisai, Merck, Novartis, Pfizer, Puma Biotechnology and Roche. Grant/research support from Astellas, AstraZeneca, Genentech, Novartis, OncoGenex, Roche and Medivation.
    Dr Marleen Kok

    Netherlands Cancer Institute, Amsterdam, Netherlands

    Marleen Kok, MD, PhD, is a medical oncologist at the Netherlands Cancer Institute (NKI), focussing on early innovative combination immunotherapy trials, of which she is the lead investigator. In addition, she is senior group leader at the Division of Tumor Biology & Immunology at NKI. read more

    After graduating from medical school in 2004, Dr Kok completed her PhD training at the NKI, working in the groups led by Laura J van ‘t Veer and Sabine Linn, and focussing on predictive biomarkers in breast cancer. From 2009 to 2015, Dr Kok did her residency in internal medicine/medical oncology. In 2015, she was awarded with a translational research fellowship of the Dutch Cancer Society. During this fellowship (2015–2019), she worked as a postdoctoral fellow in the laboratories of Ton Schumacher (NKI) and Drew Pardoll (Johns Hopkins University, Baltimore, USA) studying anti-cancer immune response in breast cancer and strategies to combine T-cell checkpoint inhibitors with chemotherapy.

    Dr Marleen Kok discloses: Advisory board or panel fees from AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Merck Sharp & Dohme, and Roche. Speaker’s bureau from Gilead Sciences; Bristol Myers Squibb and Roche (relationships terminated)
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    How are checkpoint inhibitors changing the treatment paradigm in mTNBC?
    When and where should we consider ADCs in the mTNBC treatment journey?
    What is the role of PARP inhibitors in mTNBC?
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    Breast Cancer CE/CME accredited

    touchIN CONVERSATION
    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Navigating the evolving treatment landscape in mTNBC: What are the key considerations for clinical practice today?

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    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

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

    • Evaluate clinical evidence for the use of immune checkpoint inhibitors (ICIs) in PD-L1-positive mTNBC in the first-line setting and its applicability to clinical practice
    • Translate the latest clinical evidence for approved and emerging antibody–drug conjugates (ADCs) for patients with mTNBC into current and future clinical practice
    • Outline the potential for targeted therapy with poly (ADP-ribose) polymerase (PARP) inhibitors in the BRCA-mutated TNBC treatment landscape
    Overview

    In this activity, Prof. Peter Schmid, a breast cancer specialist, and Dr Marleen Kok, a medical oncologist, discuss the evolving treatment landscape in the management of metastatic triple negative breast cancer (mTNBC). They consider the mechanisms of action, the current clinical efficacy evidence for immune checkpoint inhibitors (ICIs), antibody–drug conjugates (ADCs) and poly (ADP-ribose) polymerase (PARP) inhibitors, and how to personalize treatment. The discussion is guided by pre-canvassed questions provided by the breast cancer clinical community.

    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, including breast cancer specialists involved in the management of triple negative breast cancer.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. 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 financial relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty 

    Prof. Peter Schmid discloses: Advisory board or panel fees from AstraZeneca, Bayer, Boehringer Ingelheim, Celgene, Eisai, Merck, Novartis, Pfizer, Puma Biotechnology and Roche. Grant/research support from Astellas, AstraZeneca, Genentech, Novartis, OncoGenex, Roche and Medivation.

    Dr Marleen Kok discloses: Advisory board or panel fees from AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Merck Sharp & Dohme, and Roche. Speaker’s bureau from Gilead Sciences; Bristol Myers Squibb and Roche (relationships terminated).

    Content reviewer

    Kaitlin Hendrix, MSN, APRN, AOCNP has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Directors

    Holly Gilbert-Jones and Kathy Day have 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 questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    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 1.0 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 1.0 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.

    Date of original release: 29 September 2022. Date credits expire: 29 September 2023.

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

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    This Activity Is Funded By:

    An independent medical education grant from Gilead Sciences and is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits /contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 29 September 2022. Date credits expire:  29 September 2023.

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    touchIN CONVERSATION
    Navigating the evolving treatment landscape in mTNBC: What are the key considerations for clinical practice today?
    1.0 CE/CME credit
    Question 1/5
    A 55-year-old woman presents with primary disease and a disease-free interval of 8 months. She is negative for the BRCA1 and BRCA2 genes, but a breast-tissue biopsy reported a PD-L1 CPS >10. What would your preferred treatment option be?

    CPS, combined positive score; PD-L1, programmed death-ligand 1.

    The IMpassion130 trial investigated atezolizumab in patients with a disease-free interval of ≥12 months,1 whereas the KEYNOTE-355 trial investigated pembrolizumab and included patients with a disease-free interval of ≥6 months.2 The KEYNOTE-355 study also reported results based on PD-L1 CPS ≥1 and ≥10. While both trials showed a benefit with checkpoint inhibitors over comparator chemotherapy,1,2 this patient more closely matches the KEYNOTE-355 eligibility criteria, making pembrolizumab the more suitable choice.

    Abbreviations

    CPS, combined positive score; PD-L1, programmed death-ligand 1.

    References

    1. Schmid P, et al. N Engl J Med. 2018;379:2108–21.
    2. Cortés J, et al. Lancet. 2020;396:1817–28.
    Question 2/5
    Your patient presents with active metastatic TNBC without brain metastases that has relapsed after two prior lines of chemotherapy. She has asked to be considered for treatment with sacituzumab govitecan. What advice would you give regarding her treatment options?

    ADC, antibody–drug conjugate; TNBC, triple-negative breast cancer.

    Results from the ASCENT trial showed that in patients who had received at least two prior lines of chemotherapy, the ADC sacituzumab govitecan significantly improved PFS versus chemotherapy (5.6 months vs 1.7 months, respectively; HR 0.41, 95% CI 0.32–0.52; p<0.001) and OS (12.1 months vs 6.7 months, respectively; HR 0.48, 95% CI 0.38–0.59; p<0.001).

    Abbreviations

    ADC, antibody–drug conjugate; CI, confidence interval; HR, hazard ratio; OS, overall survival; PFS, progression-free survival.

    Reference

    Bardia A, et al. N Engl J Med. 2021;384:1529–41.

    Question 3/5
    How can trial data support the use of HER2 status to guide treatment decisions for ADC therapy such as trastuzumab deruxtecan in TNBC?

    ADC, antibody–drug conjugate; HER2, human epidermal growth factor receptor 2; PFS, progression free survival; OS, overall survival; TNBC, triple negative breast cancer.

    Patients who express HER2 but at levels too low to be classified as HER2 positive (i.e. HER2-low) account for over 20% of patients with TNBC.1 Results from the DESTINY-Breast04 trial demonstrated prolonged PFS in patients with TNBC (8.5 months vs 2.9 months; HR 0.46, 95% CI 0.24–0.89) and OS (18.2 months vs 8.3 months; HR 0.48, 95% CI 0.24–0.95) treated with trastuzumab deruxtecan versus chemotherapy, respectively.2

    Abbreviations

    CI, confidence interval; HER2, human epidermal growth factor receptor 2; HR, hazard ratio; PFS, progression free survival; OS, overall survival; TNBC, triple negative breast cancer.

    References

    1. Gampenrieder SP, et al. Breast Cancer Res. 2021;23:112.
    2.  Modi S, et al. N Engl J Med. 2022;387:9–20.
    Question 4/5
    How do PARP inhibitors trigger apoptosis in patients with a germline BRCA1/2 mutation?

    PARP, poly(ADP-ribose) polymerase.

    PARP is a family of enzymes that facilitates base excision repair following DNA single-strand breaks. PARP inhibition means single-strand breaks in DNA accumulate, which eventually results in double-strand breaks. In cells with BRCA1 or BRCA2 mutations, homologous recombination is disrupted and double-strand breaks cannot be repaired, which leads to apoptosis.

    Abbreviation

    PARP, poly(ADP-ribose) polymerase.

    Reference

    Barchiesi G, et al. Front Oncol. 2021;11:769280.

    Question 5/5
    In patients initiated on PARP inhibitor therapy, which of the following side effects can impair quality of life if not appropriately managed?

    GI, gastrointestinal; PARP, poly(ADP-ribose) polymerase.

    Nausea and GI toxicities are commonly reported in patients treated with PARP inhibitors, along with anaemia.1,2 Supportive treatments and dose interruptions can help manage treatment toxicities, allowing patients to remain on the treatment regimen.3

    Abbreviations

    GI, gastrointestinal; PARP, poly(ADP-ribose) polymerase.

    References

    1. Robson M, et al. N Engl J Med. 2017;377:523–33.
    2. Robson M, et al. Ann Oncol. 2019;30:558–66.
    3. Cortesi L, et al. Target Oncol. 2021;16:255–82.
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    This Activity Is Funded By:

    An independent medical education grant from Gilead Sciences and is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits /contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 29 September 2022. Date credits expire:  29 September 2023.

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