OncologyConsults



The Emerging Role of Immunotherapy in Treating Patients with
Triple-Negative Breast Cancer

Presented by the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing.

Supported by an educational grant from Merck & Co Inc.

OVERVIEW
Triple negative breast cancer (TNBC) is a biologically heterogeneous disease that accounts for about 15% of all breast cancers. Unlike luminal breast tumors, which express the estrogen receptor and/or progesterone receptor, and human epidermal growth factor receptor-2-overexpressing (HER-2+) breast cancers, TNBC does not express a prototypical target for therapy that has been clinically validated. Therefore, chemotherapy is the mainstay of systemic therapy for both early and late-stage TNBC. Although TNBC typically has a shorter relapse-free time frame and overall survival than other breast cancer subtypes, patients with newly diagnosed primary TNBCs that contain significant levels of tumor-infiltrating lymphocytes (TILs) have better clinical outcomes than those that do not contain TILs. This suggests the potential for harnessing the immune system as a targeted therapy for patients with TNBC. Monoclonal antibody antagonists specific for programmed death-1 (PD-1) receptor or its ligand programmed death ligand-1 (PD-L1) have now been approved for multiple solid tumors and emerging data suggest that these agents will likely play a role in the clinical management of patients with TNBC as well. This activity will review data describing the clinical activity of inhibitors specific for the PD-1/PD-L1 pathway, discuss the management considerations unique to immunotherapy relative to standard chemotherapy, and highlight future directions to enhance the activity of immunotherapy for patients with TNBC.

GOAL
The goal of this activityc is to review emerging data supporting the future clinical use of immune checkpoint blockade, antagonists of PD-1 and its ligand PD-L1, in patients with TNBC.

TARGET AUDIENCE
This activity is intended for oncology healthcare providers (oncologists, oncology physician assistants, oncology advanced practice nurses) who care for patients with TNBC. No prerequisites required.

LEARNING OBJECTIVES
After participating in this activity, the participant will demonstrate the ability to:
  • DESCRIBE the rationale for harnessing the immune system to treat TNBC.
  • EVALUATE the efficacy and safety of late-stage clinical research immunotherapeutic agents for TNBC.
  • REVIEW potential current and future clinical practice implications of immunotherapeutic agents in the treatment of TNBC.
The Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing take responsibility for the content, quality, and scientific integrity of this CME/CNE activity.

CE INFORMATION
Accreditation Statements
accme_logoThis 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 providership of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Credit Designation Statements — The Johns Hopkins University School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This .5 contact hour educational activity is provided by the Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Statements will be awarded for this educational activity until March 13, 2019.

The estimated time to complete this activity: 30 minutes.

Release date: March 12, 2018    Expiration date: March 12, 2019

Policy On Speaker and Provider Disclosure
It is the policy of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing that the speaker and provider globally disclose conflicts of interest. The Johns Hopkins University School of Medicine OCME has established policies in place that will identify and resolve all conflicts of interest prior to this educational activity. Detailed disclosure will be made in the instructional materials.

Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME. The following relationships have been reported for this activity:

Planner Disclosures
Dr. Ettinger reports serving as a principal investigator for Golden Biotechnology Corp; serving as a consultant for AbbVie Inc, BeyondSpring Pharmaceuticals, Inc, Boehringer-Ingelheim GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, EMD Serono Inc, Guardant Health Inc, Genentech Inc, Helsinn Therapeutics Inc, Herron Therapeutics, and Sanofi-aventis, US LLC.

Dr Emens reports serving as a principal investigator and has received intellectual property rights and/or is a patent holder for Aduro Biotech Inc; serving as a principal investigator for AstraZeneca, Corvus Pharmaceuticals Inc, EMD Serono Inc, F. Hoffmann-La Roche Ltd, Genentech Inc, and MaxCyte Inc; serving as a consultant for Peregrine Pharmaceuticals Inc; serving as a consultant and/or serving on the advisory board for Gritstone Oncology Inc; and serving on the scientific advisory board for Amgen Inc, AstraZeneca, Bayer, Celgene, eTheRNA immunotherapies NV, MolecuVax Inc, Vaccinex Inc, Syndax Pharmaceuticals Inc.


No other planners have indicated that they have any financial interests or relationships with a commercial entity.

Note: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

FACULTY
Chair and Planner
David S. Ettinger, MD

Alex Grass Professor of Oncology
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland

Faculty Author
Leisha A. Emens, MD, PhD

Associate Professor of Oncology
Johns Hopkins University School of Medicine
Bloomberg-Kimmel Institute for Cancer Immunotherapy
Baltimore, Maryland

Nurse Planner
Rebecca Barshick, RN, MSN

Nurse Educator
The Institute for Johns Hopkins Nursing
Baltimore, Maryland

Nurse Reviewer
MiKaela Olsen APRN-CNS, MS, AOCNS, FAAN

Oncology and Hematology Clinical Nurse Specialist
Ambulatory Oncology
Sidney Kimmel Comprehensive Cancer Center
at Johns Hopkins Hospital and Greenspring Oncology
Baltimore, Maryland

Non-Endorsement of Products
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

CONFIDENTIALITY DISCLAIMER FOR CME ACTIVITY PARTICIPANT
I certify that I am participating in this Johns Hopkins University School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am attending in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins University School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office at 410-955-2959 or e-mail cmenet@jhmi.edu.
Johns Hopkins University School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03) (Updated 4/09 and 3/14)

HARDWARE & SOFTWARE REQUIREMENTS
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

THE INSTITUTE FOR JOHNS HOPKINS NURSING MISSION STATEMENT
The mission of the Institute for Johns Hopkins Nursing is to share the innovations of Johns Hopkins Nursing in practice, education, and research—locally, nationally, and globally. Our goal in continuing nursing education is to bring you activities that reflect the expertise and creativity of Johns Hopkins Nursing. Our service values are quality, integrity, flexibility, and personal attentiveness. We appreciate your thoughts and welcome your concerns—please feel free to e-mail us: IJHN@.jhmi.edu.

ACTIVITY INSTRUCTIONS
The following is an interactive case module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, an interactive case study, and a CME/CNE post-test and evaluation. All 3 sections must be completed to receive CME/CNE credit. A certificate of participation will be available online immediately following successful completion of the activity.

Preassessment

The Emerging Role of Immunotherapy in Treating Patients with Triple-Negative Breast Cancer
Leisha A. Emens, MD, PhD

Postassessment and Evaluation


This activity was developed in collaboration with ASiM.