= Interactive polling questions

	Choices presented to the audience:
		1. I agree with first recommendation 2. First recommendation is acceptable but 3. I would recommend something different 4. First recommendation is not acceptable and I would recommend something different

= Video case presentation

7:40-8:00 PM Dr Hudis
Topic: First-line systemic therapy for patients with ER-positive, HER2-negative symptomatic visceral metastases

Video case presentation from the practice of Dr William Reeves (Youngstown, Ohio)

• A 65-year-old woman presents with abdominal cramping, early satiety, anorexia and a 10-pound weight loss over three months. Three years ago, she was treated for a 3.5-cm, strongly ER/PR-positive, HER2-negative infiltrating ductal carcinoma (IDC) with seven of 15 positive nodes with lumpectomy, FEC 100 x 6, radiation therapy and anastrozole, which she continues to receive without complications. Bone scan is negative, but CT of the abdomen reveals multiple lesions in her liver. Tumor markers (CEA and CA27.29) are normal.

First opinion: The patient comes with a recommendation to initiate treatment with paclitaxel and bevacizumab followed by bevacizumab with tamoxifen as maintenance therapy.

How would you respond if you were seeing this patient as the second opinion?

8:00-8:20 PM Dr O’Shaughnessy
Topic: Choice of taxane in the management of metastatic disease

Video case presentation from the practice of Dr Brenda Towell (Austin, Texas)

• A 55-year-old woman with a prior history at age 46 of a 1.7-cm, node-negative, ER-positive IDC, treated with lumpectomy and radiation therapy. She was started on tamoxifen but later switched to toremifine, which she took for five years. She now presents with back pain and biopsy-proven ER-positive, HER2-negative soft tissue, bone and lung metastases, consistent with the breast primary. She is first treated with letrozole then fulvestrant, with modest response followed by disease progression, now involving the liver.

First opinion: The patient comes with a recommendation to receive nab paclitaxel and bevacizumab.

How would you respond if you were seeing this patient as the second opinion?

8:20-8:40 PM Dr Budd
Topic: New research strategies in the management of ER-positive breast cancer, including combined biologic and endocrine therapy

Video case presentation from the practice of Dr William Harwin (Naples, Florida)

• A 66-year-old woman who, in 1985 at age 44 while premenopausal, was diagnosed with an ER-positive IDC with two positive nodes, for which she received CMF. Two years ago, she had a left hip replacement for aseptic necrosis, followed by chronic pain in that area. Eventually, a bone scan revealed widespread bone metastases, and CT of the abdomen showed multiple liver lesions, the largest of which was six centimeters. She was asymptomatic with a PS of 0, no hepatomegaly and normal LFTs. Needle biopsy of her liver demonstrated ER-positive, HER2-negative disease compatible with the primary. The patient had received raloxifene for osteoporosis for many years.

First opinion: The patient comes with a recommendation to enter a trial in which she will receive fulvestrant with bevacizumab.

How would you respond if you were seeing this patient as the second opinion?

	If this woman had presented two years ago, prior to the diagnosis of metastases, would you have offered an AI either on or off study?

9:00-9:20 PM Prof Forbes
Topic: Long-term adjuvant endocrine therapy for the postmenopausal patient

9:20-9:40 PM Dr Sparano
Topic: First-line systemic therapy for patients with ER-positive, HER2-positive metastatic disease

Video case presentation from the practice of Dr Reeves

• A 42-year-old premenopausal woman who was diagnosed two years ago with a 3-cm, ER-positive, HER2-positive IDC with three of 15 involved lymph nodes. She chose not to enter a randomized trial evaluating adjuvant trastuzumab and received dose-dense AC/paclitaxel followed by tamoxifen and goserelin. She now presents with bone pain and extensive skeletal metastases.

First opinion: The patient comes with a recommendation to continue goserelin and begin anastrozole and trastuzumab.

How would you respond if you were seeing this patient as the second opinion?

9:40-10:00 PM Dr Chlebowski
Topic: Endocrine management of the premenopausal patient, including the patient who ceases menstruation following adjuvant chemotherapy

Video case presentation from the practice of Dr Hussein

• A 46-year-old woman diagnosed five years ago with a 2.2-cm, ER/PR-positive, HER2-negative IDC with one of 19 nodes positive. She was treated with lumpectomy, TAC x 5 (patient refused cycle 6 due to fatigue), radiation therapy and tamoxifen. Her menses, which were normal prior to the diagnosis, ceased after the second cycle of chemotherapy. Bone density during treatment was –2.1 (Fosamax^®, vitamin D and calcium were prescribed). She will soon complete her fifth year of tamoxifen. Current blood work reveals FSH and LH low (<25) and an estradiol of 38.

First opinion: The patient comes with a recommendation to initiate a nonsteroidal AI when five years of tamoxifen are completed.

How would you respond if you were seeing this patient as the second opinion?

10:00 PM Close