Paclitaxel With Pertuzumab Plus Trastuzumab in MBC

Panelists: Adam M. Brufsky, MD, PhD, University of Pittsburgh; Sara Hurvitz, MD, UCLA;
Joyce A. O'Shaughnessy, MD, US Oncology; Edith A. Perez, MD, Mayo Clinic; Hope S. Rugo, MD, UCSF;
Andrew D. Seidman, MD, MSKCC
Published Online: Wednesday, August 28, 2013
For High-Definition, Click
The FDA approved pertuzumab in June 2012 to be used in combination with trastuzumab and docetaxel for untreated patients with HER2-positive metastatic breast cancer (MBC). This approval was based on findings from the phase III CLEOPATRA trial. However, following its approval, there was a push led by physicians at Memorial Sloan-Kettering Cancer Center (MSKCC) to allow the regimen to include paclitaxel instead of docetaxel, moderator Adam M. Brufsky, MD, PhD, states. 

At MSKCC, paclitaxel as a monotherapy and in combinations is preferred to docetaxel for the treatment of patients with MBC, suggests Andrew D. Seidman, MD. As a result, the institution undertook a phase II trial examining the safety and efficacy of paclitaxel, pertuzumab, and trastuzumab, which found similar efficacy to the combination with docetaxel.

These efforts culminated in compendia approval and an endorsement from the NCCN guidelines for the combination of weekly paclitaxel with trastuzumab and pertuzumab. However, for patients who receive adjuvant paclitaxel and relapse after a year to a year-and-a-half, docetaxel remains the preferred treatment, Seidman adds.

While the utilization of this regimen is commonly agreed upon in the frontline treatment of HER2-positive patients, determining the optimal second- and third-lines of therapy remains complex. To address this concern, institutions and organizations are developing a set of guidelines specifically for HR and HER2-positive MBC.

In closing, Seidman mentions two trials that helped establish combination strategies for patients with HR- and HER2-positive MBC. The first trial was the TAnDEM trial, which showed that trastuzumab plus anastrozole was superior to anastrozole alone for postmenopausal women. A second trial, Seidman notes, demonstrated that combining letrozole and lapatinib significantly improves progression-free survival for patients with MBC, compared to letrozole alone.

View More From This Discussion
Episode 1 Introduction and Exploration of Fulvestrant in Breast Cancer
Episode 2 Combination of Anastrozole and Fulvestrant in MBC
Episode 3 BOLERO-2 Trial: Everolimus in Metastatic Breast Cancer
Episode 4 Management of mTOR Inhibitor Side Effects in Breast Cancer
Episode 5 EMILIA Trial: T-DM1 in Metastatic Breast Cancer
Episode 6 Frontline T-DM1 in HER2+ Metastatic Breast Cancer
Episode 7 CLEOPATRA Trial: Frontline Pertuzumab for HER2+ MBC
Episode 8 MA.31 Trial: Taxane With Lapatinib or Trastuzumab
Episode 9 Treatment With Eribulin in Metastatic Breast Cancer
Episode 10 Case Study: Treating HER2-Positive MBC, Part I
Episode 11 Case Study: Treating HER2-Positive MBC, Part II
Episode 12 Paclitaxel With Pertuzumab Plus Trastuzumab in MBC
Episode 13 Case Study: Treating HR+ and HER2- Breast Cancer
Episode 14 Managing Bone Health in Metastatic Breast Cancer
Episode 15 Surgical Removal of Primary Tumors in Stage IV MBC
Episode 16 Case Study: Metastatic Triple-Negative Breast Cancer
Episode 17 Personalized Medicine in Triple-Negative Breast Cancer
Episode 18 Conclusion and Final Thoughts on Managing Breast Cancer
Expert Panelists
Dr Adam Brufsky

Adam M. Brufsky, MD, PhD

Professor of Medicine, University of Pittsburgh
Medical Director of the Women’s Cancer Center
at Magee-Womens Hospital of UPMC
and the University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania

Sara Hurvitz, MD

Assistant Professor & Director,
Hematology/Oncology Breast Cancer Program, UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California

Joyce A. O’Shaughnessy, MD

Co-Director, Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology, PA/US Oncology,
Dallas, Texas

Edith A. Perez, MD

Deputy Director of the Mayo Clinic Cancer Center, Director of the Breast Cancer Translational Genomics Program and the Breast Program at Mayo Clinic,
Jacksonville, Florida

Hope S. Rugo, MD

Professor of Medicine and Director of the Breast Oncology, Clinical Trials, and Education Program, University of California San Francisco Comprehensive Cancer Center, San Francisco, California

Andrew D. Seidman, MD

Professor of Medicine, Weill Cornell Cancer Center, Attending Physician at Memorial Sloan Kettering Cancer Center,
New York, New York
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