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CME: Hormone receptor-positive (HR+) advanced breast cancer: Where we are now and next steps


Activity Description / Statement of Need:

In this online, self-learning activity:

Over a quarter million women and almost 2,700 men in the U.S. are diagnosed with breast cancer each year, and it is the second leading cause of cancer death in women. The prognosis associated with breast has improved in the last few decades due in larger part to earlier detection. However, while detection at the loco-regional stage is associated with a five-year overall survival (OS) rate of 90%, patients with breast cancer that has progressed may expect five-year OS rates closer to 28%.

The goals of care in advanced breast cancer (ABC) include: palliation of symptoms, improvement of quality-of-life, and extension of survival. Hormone receptor positivity has traditionally conferred a better prognosis. In contrast, the presence the human epidermal growth factor receptor 2 (HER2), which is associated with a more negative prognosis. A wide array of advances in care – approved and investigational – have been or are being developed for HR+ ABC in recent years. This activity has been designed to bring healthcare professionals’ knowledge of the rationale behind treatment of HR+ ABC up to date and improve their competence and performance in treating it.

Target Audience:

Medical oncologists; physician assistants, nurse practitioners, and pharmacists who practice in oncology; and any other healthcare professionals with an interest in or who clinically encounter patients with breast cancer.

Commercial Support Disclosure: This program is supported by educational grants from Sanofi and Eisai.

This activity is free of charge.

Release Date: January 10, 2022 -- Expiration Date: January 10, 2023

Faculty: Anees Chagpar, MD


Introduction content: cursory refresher and review of HR+ ABC

  • Epidemiology: Statistics and survival
  • Pathophysiology and clinical features

Management of HR+ ABC

  • Goals of therapy
  • Locally advanced disease
  • Treatment considerations for metastatic disease

·       HER2-negative:

·       Endocrine therapy & targeted agents

·       Estrogen depletion

·       Selective estrogen receptor (ER) modulators or ER down-regulators

·       Targeted therapy

·       Cyclin-dependent kinase (CDK) 4/6 inhibitors

·       Mechanistic target of rapamycin (mTOR) inhibition

·       Tumor phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-targeting agents for those with mutations

·       Consideration of chemotherapy for: Patients with rapidly progressive, symptomatic disease or visceral metastases with end-organ dysfunction

·       HER2-positive: HER2-directed agent plus chemotherapy or endocrine therapy

·       Treatment resistance & later-line therapy

·       Additional considerations: Pre-menopausal women, men, BRCA mutation carriers

·       Emerging therapies

·       Novel selective estrogen receptor (ER) down-regulators (SERDs)

·       Selective ER alpha covalent antagonism

·       Additional PIK3CA-targeting agents

·       Type 1, 2, 3, and/or 4 fibroblast growth factor receptor antagonists

  • Treatment challenges and barriers to care [Learning objective #4]
  • Patient cases

Learning Objectives

By the end of the session the participant will be able to:

  • Describe guideline-recommended therapy for HR+ ABC.
  • Recall first- and later-line pharmacotherapies for HR+ ABC.
  • Discuss investigational therapies for HR+ ABC, their mechanisms of action, and their anticipated place in therapy.
  • List the challenges and barriers to care associated with treating patients with HR+ ABC.
  • Formulate a treatment plan for a patient with HR+ ABC.


ACCME Activity #201813468

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.


ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

PhysiciansFor maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: Not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in this section, then it does NOT provide MOC credit.


ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.00 contact hours (0.1 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-22-006-H01-P. This is an Application (A)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.

Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure:

Anees B. Chagpar, MD, Professor, Department of Surgery, Yale University School of Medicine, is on the board of directors for Protean Biodiagnostics; received royalties from UpToDate, and has received financial compensation for consulting work/speaker from Sanofi Aventis, Novartis, Guardant Health, Puma Diagnostics, Lumicell, and Athenex.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will not discuss off-label uses.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by educational grants from Sanofi and Eisai.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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