Editor’s Note
	Miami symphony

This is the third time we have gathered four clinical research leaders and about a dozen community-based medical oncologists to produce a Meet the Professors audio program. Along the way we have learned a great deal by experimenting with this dynamic case-based approach to production. Last year in Dallas, the room had a bit too much echo, while our November meeting in New York suffered from mild claustrophobia. However, for our most recent event this spring in Miami, we pretty much got it right.

Even more important than "concert hall" acoustics is the cast of musicians and the orchestral score. These events are not rehearsed but rather improvised, and as the "conductor" it is my responsibility to select symphony members who are not only talented but also quick-thinking. Our latest ensemble instantly meshed, and the result was a lively and informative day of discussion. In fact, it was extremely challenging to edit this program because there were so many valuable and interesting comments.

Prior to these Meet the Professors sessions, I routinely confer by telephone with each community-based participant to select interesting cases to spring on our research leader faculty. The research leaders walk into these meetings with no prior knowledge of the cases that will be presented. The first case you will hear in this program exemplifies the most common adjuvant clinical scenario — a postmenopausal woman with a node-negative, ER-positive tumor. When Tom Cartwright told me about this 62-year-old woman, I immediately appreciated how astute he was in suggesting this case. What makes this presentation even more interesting is that some years ago, Tom had also provided care for this patient's mother, who was treated with tamoxifen.

Tom selected this case to illustrate the changes in breast cancer management that have occurred from the prior generation to this one. His patient decided to be treated with adjuvant anastrozole and forego chemotherapy, partly because of the result of the Oncotype DX™ assay. The initial data from this fascinating new Genomic Health assay was reported by the NSABP's Soon Paik only months before at the last San Antonio Breast Cancer meeting.

From my perspective, the issues discussed in this case reflect some of the most important recent changes in breast cancer therapy since the patient's mother was diagnosed in the 1980s. On one hand we see a potential shift towards less chemotherapy and more effective hormonal therapy, and simultaneously, a shift toward focus on absolute versus relative risk reduction estimates in discussions with patients. These are highly tangible benefits now reaching patients, and each of our faculty — Peter Ravdin, Gershon Locker, Kevin Fox, and Richard Elledge — have had a role in the evolution of this change in research and practice.

The other cases selected for discussion were equally pertinent and reflect the infinite number of challenges every medical oncologist faces when treating women with this disease. You will hear these physicians discuss such challenging issues as the role of adjuvant LHRH agonists, the use of tumor markers in management of metastatic disease, compliance with oral endocrine agents (and a patient who "doesn't like doctors"), the choice of systemic agents in patients with rapidly progressive ascites and breast reconstruction in patients with metastases. It was a privilege to be the conductor of this stellar ensemble. The artists were creative, thoughtful and truly put on a great performance. I hope you enjoy their rendition and work.

— Neil Love, MD
NLove@ResearchToPractice.net

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