Dr. Mortimer on Adjuvant Therapy in Early-Stage HER2+ Breast Cancer

Joanne Mortimer, MD
Published: Thursday, May 02, 2019



Joanne Mortimer, MD, associate director for Education and Training, Comprehensive Cancer Center, Baum Family Professor in Women’s Cancers, vice chair and professor, Department of Medical Oncology & Therapeutics Research, director, Women’s Cancer Programs, City of Hope, discusses adjuvant therapy in early-stage HER2-positive breast cancer.

One of the challenges in this setting is figuring out whether there is a role for pertuzumab (Perjeta), says Mortimer. The phase III APHINITY trial looked at adjuvant trastuzumab (Herceptin) and chemotherapy with or without pertuzumab. However, the majority of patients who enrolled in the trial had negative nodes and therein a favorable outcome, she says. Now, these women would likely be treated with paclitaxel and trastuzumab without any consideration of additional adjuvant therapy.

The results of the randomized study did not show a significant advantage with the addition of pertuzumab to trastuzumab. However, there did appear to be a benefit in the subset of patients who had positive lymph nodes. Therefore, in patients with negative lymph nodes, the addition of pertuzumab is probably not needed in the adjuvant setting. Based on these data, this approach may be worth considering for those with positive lymph nodes, Mortimer concludes.
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Joanne Mortimer, MD, associate director for Education and Training, Comprehensive Cancer Center, Baum Family Professor in Women’s Cancers, vice chair and professor, Department of Medical Oncology & Therapeutics Research, director, Women’s Cancer Programs, City of Hope, discusses adjuvant therapy in early-stage HER2-positive breast cancer.

One of the challenges in this setting is figuring out whether there is a role for pertuzumab (Perjeta), says Mortimer. The phase III APHINITY trial looked at adjuvant trastuzumab (Herceptin) and chemotherapy with or without pertuzumab. However, the majority of patients who enrolled in the trial had negative nodes and therein a favorable outcome, she says. Now, these women would likely be treated with paclitaxel and trastuzumab without any consideration of additional adjuvant therapy.

The results of the randomized study did not show a significant advantage with the addition of pertuzumab to trastuzumab. However, there did appear to be a benefit in the subset of patients who had positive lymph nodes. Therefore, in patients with negative lymph nodes, the addition of pertuzumab is probably not needed in the adjuvant setting. Based on these data, this approach may be worth considering for those with positive lymph nodes, Mortimer concludes.



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