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Oncology Pharmacy Consults:
Evolving Therapies for Advanced or Metastatic Breast Cancer: A Focus on CDK 4/6 Inhibition

Provided by The University of Tennessee College of Pharmacy, in cooperation with ASiM.
Supported by an educational grant from Pfizer Inc.


Drug resistance to endocrine therapy is inevitable in patients with advanced or metastatic hormone-receptor positive (HR+) breast cancer. The number of patients with HR+ tumors is anticipated to increase in the next 15 years, driving the number of breast cancer cases up by 50%, and it can be challenging to treat patients with conventional hormonal and chemotherapy. Advances in recent years have identified key pathways responsible for hormone resistance. With the knowledge that pathways downstream of the hormone receptors are activated in patients with metastatic, endocrine therapy resistant disease, cyclin-dependent kinase (CDK) 4/6 inhibitors were developed. Many experts consider these novel targeted therapies potentially practice changing, and the role of CDK 4/6 inhibitors has been recently incorporated into the National Comprehensive Cancer Network's Clinical Practice Guidelines. The role of these agents now includes options in the first- and second-line settings in combination with endocrine therapy and as monotherapy. While similar, these agents have important differences. Pharmacists are an important part of the multidisciplinary healthcare team, often participating in key medication management strategies such as drug selection, drug dosing, management of adverse drug reactions, and patient education. Pharmacist involvement in oral chemotherapy programs has increased and has demonstrated positive outcomes. As the role of CDK4/6 inhibitors continues to expand, pharmacists will be called upon to provide expert opinions on the use of these agents. Presented in an interactive, case-based format, this activity is will contrast the mechanisms of action, dosing, efficacy, and toxicity of abemaciclib, ribociclib, and palbociclib in treating patients with metastatic breast cancer.


After completing this activity, pharmacists will have learned how CDK4/6 inhibitors positively affect HR+, HER-negative breast cancer care. Pharmacists will be able to offer expert advice on administration, drug interactions, and adverse effect management.


This enduring case-based activity is designed for oncology, health system, managed care, specialty pharmacists and other pharmacists who manage patients receiving systemic therapy for HR+ breast cancer. No prerequisites required.


The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. At the conclusion of this activity, the participant should be able to:

  • Describe the mechanism of action and rationale for use of CDK 4/6 inhibitors in the treatment of HR+ breast cancer (BC).
  • Apply the clinical trial data for CDK 4/6 inhibitors when developing pharmacotherapy plans for patients with HR+ breast cancer.
  • Manage the adverse events associated with each CDK 4/6 inhibitor.


acpeThe University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this knowledge-based activity will provide a statement for 1.0 contact hour of credit (0.10 CEU) and will be available at the completion of the activity. Successfully completing the activity and receiving credit includes: 1) attending the session; 2) watching, listening to, and participating in the educational activity; 3) completing the self-assessment instrument with a score of at least 70%. UAN: 0064-0000-18-205-H01-P. CE credit will be submitted to the NABP CPE Monitor within 30 days.  It is recommended that you check your NABP CPE Monitor e-profile database 30 days after the completion of any CE activity to ensure that your credits are posted.


This statement contains information provided to NABP from the Accreditation Council for Pharmacy Education (ACPE) via CPE Monitor®. ACPE policy states paper and/or electronic statements of credit may no longer be distributed directly to learners as proof of ACPE credit. The official record of credit may be located in the learner’s e-profile in CPE Monitor®. It is recommended that you check your e-profile in CPE Monitor® a few weeks after completion of any CE activity to ensure that your credits are posted. If you don’t see your CE credits correctly displayed from this activity, contact the University of Tennessee College of Pharmacy at jwheele4@uthsc.edu.

Please allow up to 30 days for your credit to appear on CPE Monitor.

Type of Activity: Knowledge
Media: Internet
Fee Information: There is no fee for this educational activity.

Estimated time to complete activity: 60 minutes


November 15, 2018


November 15, 2019


Participants must complete the activity as described above in the Credit Designation Statement. To answer the questions, click on your selected choice for each answer then proceed to the next question. We recommend that you print a copy of your answers before you submit them to us. Once completed, click on Submit Post-test at the bottom of the page. Your post-test will automatically be graded. If you successfully complete the post-test (score of 70% or higher), your statement of CE credit will be made available immediately. Click on View Certificate and print the CE statement for your records. If you receive a score lower than 70%, you will receive a message notifying you that you did not pass the post-test. You will have 2 opportunities to pass the post-test.


As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Course Director and Participating Faculty reported the following:


Larry W. Buie, PharmD, BCOP, FASHP
Adult Residency Program Director/ Manager, Clinical Pharmacy Services
Memorial Sloan Kettering Cancer Center
New York, New York
Dr. Buie reports serving as a consultant for Heron Pharmaceuticals and Pfizer Inc.


In accordance with ACPE Criteria for Quality, the audience is advised that authors in this CPE activity may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices. The author will inform the reader of when they discuss or reference an unapproved, unlabeled, or investigational use of therapeutic agent or biomedical device.


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 The University of Tennessee College of Pharmacy 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.

Grievance Policy

A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing at gfarr@utasip.com. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review.


The following is an interactive case simulation 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 CPE post-test, and evaluation. All 3 sections must be completed to receive CPE credit. A statement of credit will be available online immediately following successful completion of the activity.


Please ensure the computer you plan to use meets the following minimum requirements:

  • Operating System: Windows 98 or higher & Macintosh 2.2 or higher
  • Internet Browser (Mac &/Windows): Internet Explorer 6.0 or higher, Google Chrome, Safari 5.0.6 or higher, Firefox 3.0.3 or higher & Opera 5 or higher
  • Broadband Internet connection: Cable, High-speed DSL & any other medium that is internet accessible.
  • Peripherals: Computer speakers or headphones
  • Monitor Screen Resolution: 320 x 480 or higher
  • Media Viewing Requirements: Adobe Reader, Microsoft Power Point, Flash Player & HTML5



Oncology Pharmacy Consults: Evolving Therapies for Advanced or Metastatic Breast Cancer –  A Focus on CDK 4/6 Inhibition
Larry W. Buie, PharmD, BCOP, FASHP

Postassessment and Evaluation