Strategies for Managing Metastatic Breast Cancer

Release date: September 2011
Expiration date: September 30, 2012
Estimated time to complete activity: 45 minutes

Jointly sponsored by Curatio CME Institute, the Bone and Cancer Foundation, and the Cancer and Bone Society

This activity is supported by an educational donation provided by Amgen.

Hardware/Software Requirements

Javascript-enabled browser
Active Internet connection
Adobe Acrobat Reader
Adobe Flash Player plugin v.8.0+

Activity Overview
This case-based activity features clinical insights by Dr. Alison Stopeck on the management of skeletal-related events in a patient with advanced breast cancer. Issues such as pain, quality of life, risk of multiple fractures, and survival are discussed.

Learning Objectives
After completing this activity, participants should be able to:

Identify the clinical impact of untreated bone loss and bone metastasis on fracture risk, overall health, quality of life, and survival
Explain the mechanisms of cancer-related bone loss and metastasis
Describe new therapeutic approaches to manage bone complications associated with breast cancer
Use current standards and evidence-based practices in the prevention and treatment of breast cancer–related bone disease

Target Audience
This activity has been designed to meet the educational needs of medical and surgical oncologists as well as other health care providers involved in the management of patients with bone disease that is associated with advanced breast cancer.

Steering Committee
Allan Lipton, MD—Activity Chair
Professor, Departments of Medicine and Microbiology
Pennsylvania State University College of Medicine
Chief, Division of Oncology
Milton S. Hershey Medical Center of Pennsylvania State University
Hershey, Pennsylvania

Adam M. Brufsky, MD, PhD, FACP
Professor of Medicine
Associate Division Chief
Department of Medicine, Division of Hematology/Oncology
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania

Alison T. Stopeck, MD
Associate Professor of Medicine
Director, Clinical Breast Cancer Program
Director, Arizona Hemophilia & Thrombosis Center
Director, Inpatient Consult Service
Arizona Cancer Center, University of Arizona
Tucson, Arizona

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Curatio CME Institute, the Bone and Cancer Foundation, and the Cancer and Bone Society. Curatio CME Institute is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Curatio CME Institute designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period September 2011 to September 30, 2012, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, and (3) complete the posttest and activity evaluation form, including the certificate information section.

To obtain a certificate, participants must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com.

Medium
This activity is offered as an Internet activity on BoneOncologyTX.com. Offering this CME activity online allows participants to learn on their own time and at their own pace. The interactive nature of the activity allows participants to become engaged and offers visual, written, and spoken education to suit many learning styles.

Disclosure
In accordance with the ACCME Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

Allan Lipton, MD, has disclosed the following relevant financial relationships:

Speakers Bureau, Consultant, Grant Support	Amgen, Novartis
Expert Testimony	Novartis

Adam M. Brufsky, MD, PhD, FACP, has disclosed no relevant financial relationships.

Dr. Brufsky discusses the unlabeled or investigational use of a commercial product.

Alison T. Stopeck, MD, has disclosed the following relevant financial relationships:

Consultant	Amgen, Bayer, Biogen, Grifols, Novartis
Speaker	Gemomic Health

Dr. Stopeck discusses the unlabeled or investigational use of a commercial product.

Curatio CME Institute
Shari J. Dermer, PhD, Director, Scientific Services, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Senior Managing Editor, has disclosed no relevant financial relationships.
Derek Warnick, CME Director, has disclosed no relevant financial relationships.

Bone and Cancer Foundation
Charlene Waldman, Executive Director, has disclosed no relevant financial relationships.

Cancer and Bone Society
Jeanette Ruby, Director of Development, has disclosed no relevant financial relationships.

Disclaimer
The information presented at this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.

Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute, the Bone and Cancer Foundation, the Cancer and Bone Society, and Amgen do not recommend the use of any agent outside the labeled indications.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute, the Bone and Cancer Foundation, the Cancer and Bone Society, or Amgen. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/Investigational Use
Clodronate	Bonefos	Treatment of hypercalcemia of malignancy (outside the U.S.; not approved by the US FDA)	Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss
Denosumab	Xgeva	Prevention of skeletal-related events in patients with bone metastases from solid tumors	Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss
Ibandronate	Boniva	Treatment and prevention of osteoporosis in postmenopausal women	Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss
Zoledronic acid	Zometa	Treatment of hypercalcemia of malignancy; treatment of multiple myeloma; treatment of solid tumors with documented metastasis to bone (in conjunction with standard antineoplastic therapy); treatment of prostate cancer that has progressed after hormonal therapy	Treatment and prevention of bone metastases; treatment and prevention of cancer therapy–induced bone loss

Generic to Trade Names

Generic Name	Trade Name
Alendronate	Fosamax
Anastrozole	Arimidex
Clodronate*	Bonefos
Denosumab	Xgeva
Etidronate†	Didronel
Exemestane	Aromasin
Ibandronate	Boniva
Letrozole	Femara
Pamidronate	Aredia
Risedronate	Actonel
Tamoxifen	Nolvadex
Tiludronate†	Skelid
Zoledronic acid	Zometa

*Not FDA-approved for use in the U.S.
†Indicated for Paget's disease

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