STATEMENT OF NEED/TARGET AUDIENCE

It is important for practicing oncologists to be aware of similarities and differences between his or her practice patterns, those of others in community practice and those of breast cancer clinical research leaders. It is also important for oncologists to recognize that heterogeneity exists in the oncology community, especially in clinical situations for which there is suboptimal research evidence.

This program focuses on the self-described practice patterns of randomly selected medical oncologists on a variety of key clinical issues in cancer. Also included is research leader commentary and references addressing these issues. This CME program will provide medical oncologists with information on national cancer patterns of care to assist with the development of clinical management strategies.

GLOBAL LEARNING OBJECTIVES FOR THE PATTERNS OF CARE SERIES

Upon completion of this activity, participants should be able to:

• Compare and contrast management strategies of community oncologists and cancer research leaders for the treatment of cancer.
• Discuss cancer management issues for which relative agreement and heterogeneity exist in patterns of care.
• Counsel cancer patients about multiple acceptable treatment options when they exist.

PURPOSE OF THIS ISSUE

The purpose of this issue of Patterns of Care is to support these objectives by comparing the perspectives of 100 randomly selected community medical oncologists interviewed in depth in August and September of 2005 with those of 45 breast cancer researchers surveyed, and to offer in-depth commentary from faculty regarding their practice patterns in the management of breast cancer.

ACCREDITATION STATEMENT

Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT

Research To Practice designates this educational activity for a maximum of 2.25 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

HOW TO USE THIS MONOGRAPH

This monograph is one issue of a CME series activity. To receive credit for this activity, the participant should read the monograph and complete the evaluation located in the back of this book or on our website PatternsofCare.com. PowerPoint files of the graphics contained in this document can be downloaded at PatternsofCare.com.

COMMERCIAL SUPPORT

This program is supported by education grants from Abraxis Oncology, AstraZeneca Pharmaceuticals LP and Genentech BioOncology.

PHARMACEUTICAL AGENTS DISCUSSED IN THIS PROGRAM

This educational activity includes discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

FACULTY AFFILIATIONS/CONTENT VALIDATION AND DISCLOSURES

Research To Practice is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CME activities. Real or apparent conflicts of interest are identified and resolved by a peer review content validation process. The content of each activity is reviewed by both a member of the scientific staff and an external independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

The scientific staff and consultants for Research To Practice are involved in the development and review of content for educational activities and report the following real or apparent conflicts of interest for themselves (or their spouses/partners) that have been resolved through a peer review process: Terry Ann Glauser, MD, MPH, Richard Kaderman, PhD, Neil Love, MD, Douglas Paley, Michelle Paley, MD, Margaret Peng, Lilliam Sklaver Poltorack, PharmD and Kathryn Ault Ziel, PhD — no real or apparent conflicts of interest to report; Sally Bogert, RNC, WHCNP — shareholder of Amgen Inc. Research To Practice receives education grants from Abraxis Oncology, Amgen Inc, AstraZeneca Pharmaceuticals LP, Biogen Idec, Genentech BioOncology, Genomic Health Inc, Roche Laboratories Inc and Sanofi-Aventis, who have no influence on the content development of our educational activities.

In addition, the following faculty (and their spouses/partners) have reported real or apparent conflicts of interest that have been resolved through a peer review process: Michael Baum, MD, ChM: Emeritus Professor of Surgery and Visiting Professor of Medical Humanities, University College London, London, United Kingdom. Grants/Research Support and Consulting Fees: AstraZeneca Pharmaceuticals LP; Honorarium: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Pfizer Inc. Joanne L Blum, MD, PhD: Director, Hereditary Cancer Risk Program and Research Site Leader, Baylor-Charles A Sammons Cancer Center, Dallas, Texas. Speakers Bureau: American BioScience Inc, AstraZeneca Pharmaceuticals LP, Myriad Genetics Inc, Roche Laboratories Inc, Sanofi- Aventis. Adam M Brufsky, MD, PhD: Assistant Professor of Medicine, University of Pittsburgh, Member, University of Pittsburgh Cancer Institute, Director, Comprehensive Breast Cancer Center, Associate Division Chief, University of Pittsburgh, Department of Medicine, Division of Hematology/Oncology, Pittsburgh, Pennsylvania. Grants/Research Support, Honorarium and Speakers Bureau: Bristol-Myers Squibb Company, Genentech BioOncology, Sanofi-Aventis. Harold J Burstein, MD, PhD: Assistant Professor of Medicine, Harvard Medical School, Breast Oncology Center, Dana-Farber Cancer Institute, Boston, Massachusetts. Grants/Research Support: Genentech BioOncology. Robert W Carlson, MD: Professor of Medicine, Division of Oncology and Stanford Medical Informatics, Stanford University Medical Center, Stanford, California. Consulting Fees: AstraZeneca Pharmaceuticals LP. Rowan T Chlebowski, MD, PhD: Professor of Medicine, David Geffen School of Medicine at UCLA, Chief, Medical Oncology, Harbor-UCLA Medical Center, Torrance, California. Grants/Research Support: Amgen Inc, Pfizer Inc; Consulting Fees and Other Financial/Material Support: AstraZeneca, Pharmaceuticals LP, Eli Lilly and Company, Novartis Pharmaceuticals, Organon, Pfizer Inc, Sanofi-Aventis. Jack Cuzick, PhD: John Snow Professor of Epidemiology, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and the London, Queen Mary’s School of Medicine and Dentistry, London, United Kingdom. Consulting Fees: AstraZeneca Pharmaceuticals LP, Eli Lilly and Company, Pfizer Inc. Nancy E Davidson, MD: Professor of Oncology, Breast Cancer Research Chair in Oncology, Director of the Breast Cancer Research Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Consulting Fees and Honorarium: AstraZeneca Pharmaceuticals LP; Speakers Bureau: Eli Lilly and Company. Maura N Dickler, MD: Assistant Attending Physician, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York. Grants/Research Support: Genentech BioOncology; Consulting Fees: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Pfizer Inc. J Michael Dixon, MD: Consultant Surgeon and Senior Lecturer, Academic Office, Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom. Grants/ Research Support: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Pfizer Inc. Mitchell Dowsett, PhD: Professor of Biochemical Endocrinology, Head of Academic Department of Biochemistry, Royal Marsden Hospital, London, England. Grants/Research Support and Honorarium: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Roche Laboratories Inc; Consulting Fees: AstraZeneca Pharmaceuticals LP, Eli Lilly and Company, Novartis Pharmaceuticals, Roche Laboratories Inc. Charles E Geyer Jr, MD: Director of Medical Affairs, National Surgical Adjuvant Breast and Bowel Project, Director of Breast Medical Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania. Advisory Board: EMD Pharmaceuticals Inc, Genentech BioOncology, GlaxoSmithKline, Pfizer Inc, Roche Laboratories Inc, Sanofi-Aventis. Michael Gnant, MD: Professor of Experimental Surgical Oncology, Medical University of Vienna, Vienna, Austria; Grants/Research Support and Honorarium: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Sanofi-Aventis. William J Gradishar, MD: Director, Breast Medical Oncology, Associate Professor of Medicine, Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Grants/Research Support: Abraxis Oncology, AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Sanofi-Aventis; Consulting Fees and Honorarium: Amgen Inc, GlaxoSmithKline, Roche Laboratories Inc. Daniel F Hayes, MD: Professor of Internal Medicine, Clinical Director, Breast Oncology Program, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan. Grants/Research Support: Amgen Inc, Bristol-Myers Squibb Company, Genentech BioOncology, Immunicon Corporation, Novartis Pharmaceuticals, Sanofi- Aventis; Consulting Fees and Honorarium: AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Dako Diagnostics AG, Genomic Health Inc, Immunicon Corporation, Novartis Pharmaceuticals, Roche Laboratories Inc, Sanofi-Aventis, Wyeth. I Craig Henderson, MD: Adjunct Professor of Medicine, University of California, San Francisco, San Francisco, California; Consulting Fees: AstraZeneca Pharmaceuticals LP, Eli Lilly and Company, Novartis Pharmaceuticals, Pfizer Inc; Stock Shareholder: Keryx Biopharmaceuticals Inc. Gabriel N Hortobagyi, MD: Professor of Medicine, Nellie B Connally Chair in Breast Cancer, Chairman, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Consulting Fees: Pfizer Inc, Honorarium: AstraZeneca Pharmaceuticals LP, Pfizer Inc, Sanofi-Aventis. Anthony Howell, MD: Professor of Medical Oncology, University of Manchester, Manchester, England. Consulting Fees and Honorarium: AstraZeneca Pharmaceuticals LP. Speakers Bureau: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals. Clifford Hudis, MD: Chief, Breast Cancer Medicine Service, Solid Tumor Division, Memorial Sloan-Kettering Cancer Center, New York, New York. Grants/Research Support and Honorarium: Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Genentech BioOncology, Pfizer Inc, Roche Laboratories Inc, Sanofi-Aventis. Consulting Fees: Amgen Inc, AstraZeneca Pharmaceuticals LP, Bristol- Myers Squibb Company, Eli Lilly and Company, Genentech BioOncology, Genomic Health Inc, Pfizer Inc, Roche Laboratories Inc, Sanofi- Aventis. Stock Shareholder: Genomic Health Inc. Raimund V Jakesz, MD: Department of Surgery, Vienna Medical School, President, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria. Grants/Research Support: AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals; Honorarium: Amgen Inc, AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Pfizer Inc. Stephen E Jones, MD: Director, Breast Cancer Research, Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas, Chair, US Oncology Breast Cancer Research, Medical Director, US Oncology Research, Houston, Texas; Consulting Fees: AstraZeneca Pharmaceuticals LP; Honorarium: AstraZeneca Pharmaceuticals LP, Roche Laboratories Inc. Gershon Locker, MD: Kellogg Scanlon Chair of Oncology, Evanston Northwestern Healthcare, Professor of Medicine, Northwestern University, Feinberg School of Medicine, Evanston, Illinois. Grants/Research Support: AstraZeneca Pharmaceuticals LP; Consulting Fees and Honorarium: AstraZeneca Pharmaceuticals LP, Sanofi-Aventis. John Mackey, MD: Medical Oncologist, Cross Cancer Institute, Associate Professor, Medical and Experimental Oncology, University of Alberta, Chair, Northern Alberta Breast Cancer Program, Canadian Leader, Breast Cancer International Research Group, Alberta, Canada. Grants/Research Support and Honorarium: Amgen Inc, AstraZeneca Pharmaceuticals LP, Novartis Pharmaceuticals, Roche Laboratories Inc, Sanofi-Aventis; Consulting Fees: Sanofi- Aventis. Eleftherios P Mamounas, MD, MPH: Associate Professor of Surgery, Northeastern Ohio Universities College of Medicine, Medical Director, Aultman Cancer Center, Canton, Ohio. Consulting Fees: AstraZeneca Pharmaceuticals LP, Eli Lilly and Company, Novartis Pharmaceuticals, Pfizer Inc, Sanofi- Aventis; Honoraria: AstraZeneca Pharmaceuticals LP, Genomic Health Inc, Novartis Pharmaceuticals, Pfizer Inc, Sanofi- Aventis. Joyce O’Shaughnessy, MD: Co- Director, Breast Cancer Research Program, Baylor-Charles A Sammons Cancer Center, US Oncology, Dallas, Texas. Speakers Bureau: Eli Lilly and Company, Roche Laboratories Inc, Sanofi-Aventis. Edith A Perez, MD: Professor of Medicine, Mayo Medical School, Director, Cancer Clinical Study Unit, Director, Breast Cancer Program, Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida; Grants/Research Support: Genentech BioOncology, Novartis Pharmaceuticals, Sanofi-Aventis. Peter M Ravdin, MD, PhD: Clinical Professor of Medicine, The University of Texas, Health Science Center at San Antonio, San Antonio, Texas. Grants/Research Support: AstraZeneca Pharmaceuticals LP ; Consulting Fees: Pfizer Inc, Sanofi-Aventis; Ownership: Adjuvant! Inc. Edward H Romond, MD: Associate Professor of Medicine, Division of Hematology/Oncology, University of Kentucky, Lexington, Kentucky, No financial interests or affiliations to disclose. Dennis J Slamon, MD, PhD: Professor of Medicine, Chief, Division of Hematology/Oncology, Director of Clinical/Translational Research, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, California. Ownership Interest: Amgen Inc, Schering-Plough Corporation; Honoraria: Genentech BioOncology, NewBiotics Inc, Pfizer Inc, Roche Laboratories Inc, Sanofi-Aventis; Consulting Fees: NewBiotics Inc, Pfizer Inc. George W Sledge Jr, MD: Professor of Medicine, Ballve-Lantero of Oncology, Indiana University Medical Center, Indianapolis, Indiana; Consulting Fees: Genentech BioOncology. Debu Tripathy, MD: Professor of Internal Medicine, Director, Komen UT Southwestern Breast Cancer Research Program, University of Texas Southwestern Medical Center, Dallas, Texas. Grants/ Research Support: Genentech BioOncology, GlaxoSmithKline, Roche Laboratories Inc; Consulting Fees: EMD Pharmaceuticals Inc, Genentech BioOncology, Roche Laboratories Inc. Eric P Winer, MD: Director, Breast Oncology Center, Dana-Farber Cancer Institute, Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts. Speakers Bureau: Genentech BioOncology. Norman Wolmark, MD: Professor and Chairman, Department of Human Oncology, Allegheny General Hospital, Professor, Drexel University College of Medicine, Chairman, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, Pennsylvania. Consulting Fees: Sanofi-Aventis