Learning objectives

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1. Explain evolution and rationale for maintenance de-escalation in 1L HER2⁺ MBC:**

• Summarise the shift from CLEOPATRA’s model to current de-escalation trials, describing survival and QoL gains.
• Define optimal timing to begin maintenance therapy
• Identify clinical markers for safely shortening or re-escalating cytotoxic therapy in practice.

2. Understand the role of endocrine therapy ± CDK4/6 inhibitors in HE2R+/HR+ MBC 1L setting:

• Review ER–HER2 cross-talk and key data (including PERTAIN, PATINA, monarcHER) supporting endocrine layering.
• Select and sequence ET agents and CDK4/6 inhibitors based on patient factors, exposure, and toxicity.
• Manage resistance and adherence through dual-targeting strategies and patient engagement.

3. Evaluate multi-drug maintenance strategies including TKIs and ADCs:

• Evaluate the latest evidence for adding TKIs or switching/layering ADCs.
• Balance efficacy endpoints, CNS benefits, and toxicity profiles when choosing TKIs vs ADCs.
• Sequence and dose-modify multi-drug regimens.

4. Apply patient-centred, QoL-focused decision-making to personalize maintenance regimens:

• Match regimen intensity to tumour biology, disease tempo and CNS risk.
• Adjust doses, schedules, or drug combinations to mitigate toxicity and align with patient goals.
• Use shared-decision tools to accommodate comorbidities, lifestyle, and survivorship priorities.

5. Evaluate guidelines and latest evidence to understand the treatment paradigm and 1-L standard of care evolution for patients with HER2+ MBC

• Synthesize current guideline recommendations and ongoing studies.
• Map decision points from induction through maintenance and later-line transitions.

This program is supported by an independent education grant from Pfizer Global Medical Grants. This online education program has been designed solely for healthcare professionals in the USA. The content is not available for healthcare professionals in any other country.

Continuing Education Information

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

Disclosures Below is a listing of all individuals who are involved in the planning and implementation of this accredited continuing education activity. All relevant financial relationships listed for these individuals have been mitigated.​

Dr. Mark Pegram has disclosed financial relationships within the past 24 months with the following ineligible companies. He has received consulting fees from Astra-Zeneca, Roche/Genentech, Daiichi Sankyo, SeaGen/Pfizer, Novartis, Puma Biotechnology, and Stemline Therapeutics. These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education. Dr Pegram intends to discuss non-FDA uses of drug products and/or devices and their unlabelled indications, and will disclose this to the audience when such discussion takes place.

Dr Rupert Bartsch has disclosed financial relationships with the following ineligible companies within the past 24 months: Amgen, AstraZeneca, Bristol Myers Squibb (BMS), Daiichi Sankyo, Eisai, Eli Lilly, Grünenthal, MSD, Novartis, Roche Pharmaceuticals, and Gilead Sciences. These relationships include advisory roles, lecture honoraria, research support, and travel support.

Dr Sarah Sammons has disclosed financial relationships within the past 24 months with the following ineligible companies: Daiichi Sankyo, Relay Therapeutics, Seagen, Sermonix, AstraZeneca, Gilead, Eli Lilly, Incyclix, Pfizer, and Novartis. These relationships include research funding and consulting/advisory roles.

AffinityCE/MedAll staff and the planners and reviewers of this educational activity have no relevant financial or non-financial interests to disclose.​

Mitigation of Relevant Financial Relationships AffinityCE 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 CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. Relevant financial relationships were mitigated by the peer review of content by non-conflicted reviewers prior to the commencement of the program.

Activity Accreditation for Health Professions

Physicians This activity will be planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and Medall. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE will designate this live activity for a maximum of 0.25 AMA PRA Category 1 Credits™.

Other Professionals All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

Available until Feb 28th 2026