CME CREDIT INFORMATION

There are 5 presentations and 5 clinical case studies. There are 8 sessions which vary in length and will permit you to earn up to 2 hours of AMA PRA Category 1 Credits™. Sessions can be individually reviewed for credit. You can participate in as few or as many as you desire.

The format of this activity is designed to maximize the use of adult learning principles.

An effective way to prevent skeletal-related events is to treat the cancer itself. However, the unique biology of bone metastasis warrants specific treatment approaches. Although radiopharmaceuticals are sometimes used to control bone pain, systemic treatment of patients with bone metastases is primarily with the use of bisphosphonates. The achieved mechanism of action for bisphosphonates is not well understood; however, they appear to exert their therapeutic effects through osteoclast activity.

Although bisphosphonates are valuable agents in reducing the risk of skeletal-related events in breast cancer patients, it is clear that improved treatments are needed. Despite the initiation of a bisphosphonate therapy, up to two-thirds of breast cancer patients will experience a skeletal-related event. The benefits of bisphosphonate therapy are also time-dependent; the reduction in skeletal-related morbidity is generally observed after 6 months of therapy. Moreover, the use of bisphosphonates has been associated with severe adverse events, including renal impairment, hypocalcaemia and osteonecrosis of the jaw. Generally, bisphosphonates have not been shown to increase survival in breast cancer patients with bone metastases.

There are currently several bisphosphonates that have been approved in the US for the treatment of bone metastases in patients with breast cancer; however, it is unknown whether one bisphosphonate is clearly better than the others, when both efficacy and safety are considered. Outstanding questions regarding the use of bisphosphonates also include, when to start therapy, the duration of therapy, and which patients are likely to benefit from bisphosphonates. Thus, there is a need to review the clinical data regarding the use of bisphosphonates in the treatment of breast cancer patients with metastases to the bone and to discuss both efficacy and safety issues pertaining to the use of these agents.

The bone of patients with breast cancer can also be compromised with the use of aromatase inhibitors and other treatments that target the estrogen pathway. These agents have been shown to decrease bone mineral density, increase bone turnover markers and induce bone loss. Currently, breast cancer patients who receive aromatase inhibitors are also treated with bisphosphonates. Thus, there is a need to discuss the management of bone integrity in breast cancer patients who receive hormonal therapy.

Increased understanding of bone biology and the process of bone metastasis have led to the identification of a new molecular target for the development of drug therapies: RANK Ligand. The expression of RANK Ligand is stimulated by cancer cells upon metastasis to the bone. When RANK Ligand is secreted, it activates a variety of osteotropic factors and induces osteoclast formation. By blocking RANK Ligand, bone remodeling is inhibited. A phase II clinical trial of breast cancer patients with bone metastases revealed a reduction in bone turnover markers and an increase of the estimated time to first (on-study) skeletal-related event in patients who received an investigational monoclonal antibody targeting RANK Ligand compared to patients who received IV bisphosphonates. Because RANK Ligand is a new target for the treatment of patients with bone metastases, a review of the biology of RANK Ligand and the results of clinical trials targeting RANK Ligand is warranted. Currently, a phase III clinical trial to evaluate inhibition of RANK Ligand for the treatment of breast cancer patients with bone metastases is underway.

The Oncology Learning Center designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

All faculty and OLC staff participating in the content, planning or implementation of an educational CME activity are required to disclose to the audience of the educational activity any relevant financial relationships or interests and to assist in the resolution of any conflict of interest that may arise from the relationship(s) or interest(s). It is also the policy of the OLC to require all faculty presenters to make a meaningful disclosure to the audience of their discussions of unlabeled or FDA unapproved drugs, products, tests or devices. This information will be available as part of the educational activity and related material.

The following faculty and OLC staff have reported real or potential relevant conflicts of interest and these conflicts have been resolved, prior to this educational activity through a peer-review process by two medical oncologists who have had no affiliation with this educational activity other than the peer review process.  This is documented on this page immediately following the financial disclosures below.

Sincere appreciation is extended to Amgen for their generous support of this educational meeting