Sara A. Hurvitz, MD, director of the Breast Oncology Program, medical director of the Clinical Research Unit, University of California, Los Angeles Jonsson Comprehensive Cancer Center, discusses the role of pertuzumab in HER2-positive breast cancer.
Sara A. Hurvitz, MD, director of the Breast Oncology Program, medical director of the Clinical Research Unit, University of California, Los Angeles Jonsson Comprehensive Cancer Center, discusses the role of pertuzumab (Perjeta) in the treatment of patients with HER2-positive breast cancer.
Pertuzumab combined with trastuzumab (Herceptin) is currently the standard frontline therapy for patients with newly diagnosed HER2-positive disease. Hurvitz says this is based on data from the CLEOPATRA study, which showed an improvement in progression-free survival with the addition of pertuzumab to capecitabine and trastuzumab versus the combination without pertuzumab. The standard second-line option seems to be ado-trastuzumab emtansine (T-DM1; Kadcyla), she adds.
In the neoadjuvant setting, pertuzumab was shown to improve pathologic complete response rates compared with trastuzumab-based chemotherapy, which led to the FDA approval for this indication in 2013. Those trials were not designed to evaluate a full year of pertuzumab; patients only received the therapy in the neoadjuvant setting.
The APHINITY study was designed to assess 1 year of pertuzumab in combination with trastuzumab versus the standard year of trastuzumab alone. While the study met its primary endpoint, the difference in between the arms was miniscule and appeared to be limited to lymph-node positive disease. As such, Hurvitz admits that she only utilizes pertuzumab in the adjuvant setting if her patients have high levels of lymph node involvement.