Frontline Pertuzumab for Metastatic Breast Cancer

Panelists: Kimberly L. Blackwell, MD, Duke; Adam M. Brufsky, MD, PhD, University of Pittsburgh;
Joyce A. O’Shaughnessy, MD, US Oncology; Mark D. Pegram, MD, Stanford; Hope S. Rugo, MD, UCSF;
Denise A. Yardley, MD, Sarah Cannon
Published Online: Tuesday, February 4, 2014
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The combination of docetaxel (Taxotere), trastuzumab (Herceptin), and pertuzumab (Perjeta) was approved by the FDA to treat patients with HER2-positive metastatic breast cancer based on results from the phase III CLEOPATRA trial. This study provided ample category 1 evidence to support this regimen as the preferred first-line standard of care for patients in this space, moderator Adam M. Brufsky, MD, PhD, states.

At this point in time, the pertuzumab combination is the first-line standard of care. However, Mark D. Pegram, MD, suggests this could change, once results from the phase III MARIANNE trial are made available. This study is exploring T-DM1 plus pertuzumab or placebo versus trastuzumab plus a taxane for patients with untreated metastatic breast cancer.

The most striking item in the CLEOPATRA study was the lack of additional toxicities, Pegram states. Overall the treatment regimen is well tolerated and effective. Adding to this, Kimberly L. Blackwell, MD, suggests that an analysis of the survival curves suggests the majority of the benefits are coming from the two antibodies. As a result, optimal outcomes are still achieved if the chemotherapy is stopped after 6 cycles.

Paclitaxel can be substituted for docetaxel in the combination. In this situation, Hope S. Rugo, MD, recommends dosing paclitaxel continuously for 4 to 6 weeks until a response is achieved. At this point, paclitaxel can be switched to a 2 week on with 1 week off schedule to synchronize with the pertuzumab schedule.

A subset analysis of the CLEOPATRA examined patients that had received prior adjuvant trastuzumab, Pegram notes. Overall, outcomes were similar in these patients to the intent-to-treat population, suggesting that patients who’ve received adjuvant trastuzumab may still benefit from pertuzumab-based first-line treatment.
View More From This Discussion
Episode 1 Overview of HER2-Targeted Therapies in Breast Cancer
Episode 2 Treating Low-Risk HER2-Positive Breast Cancer
Episode 3 Frontline Pertuzumab for Metastatic Breast Cancer
Episode 4 PIK3CA Mutations in HER2-Positive Breast Cancer
Episode 5 T-DM1 in HER2-Positive Metastatic Breast Cancer
Episode 6 Recommendations for Optimal HER2 Testing in Breast Cancer
Episode 7 Role of Lapatinib in HER2-Positive Breast Cancer
Episode 8 Novel Drug Development in Breast Cancer
Episode 9 Phase III Clinical Trials in HER2-Positive Breast Cancer
Episode 10 Case Study: HER2-Positive Oligometastatic Breast Cancer
Episode 11 Upfront Treatment of HR-Positive MBC
Episode 12 Next Steps for Everolimus in Metastatic Breast Cancer
Episode 13 CDK4/6 Inhibitors in Metastatic Breast Cancer
Episode 14 Chemotherapeutics in Metastatic Breast Cancer
Episode 15 Preventing Skeletal-Related Events in Breast Cancer
Episode 16 Conclusion: Future Direction of Breast Cancer Treatment
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

Kimberly L. Blackwell, MD

Professor of Medicine
Assistant Professor in Radiation Oncology
Duke Cancer Institute
Durham, North Carolina

Joyce A. O’Shaughnessy, MD

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

Mark D. Pegram, MD

Professor of Medicine (Oncology)
Stanford University Medical Center;
Susy Yuan-Huey Hung Professor;
Associate Director of Clinical Research and Director, Breast Cancer Program, Stanford Cancer Institute, Stanford, California

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

Denise A. Yardley, MD

Senior Investigator, Breast Cancer Research
Sarah Cannon Research Institute, Tennessee Oncology, Nashville, Tennessee
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