Perjeta and Herceptin with no Taxotere – pro
Hereceptin and Perjeta is a tempting combination to use without chemotherapy; however, there are no clincial trials to support it at this time, and many key opinion leaders think that it is only useful in some subsets of patients, whom we cannot yet identify, and that chemotherapy is still needed with these two agents.
The recent review by Richard et al concludes: “Results of biomarker analysis in the CLEOPATRA (Baselga et al. 2014) trial were consistent with those with smaller TRYPHAENA and NeoSphere of neoadjuvant trastuzumab plus pertuzumab in patients with HER2 positive early breast cancer, where the primary efficacy end-point was pCR (. The PI3KCA status identified a subpopulation of patients with HER2-positive disease with poor prognosis when treated with anti-HER2 antibodies. Based on the findings of CLEOPATRA trial, clinical trials of HER2-targeted molecules in combination with PI3K pathway targeted agents may therefore be justified.”
There was a recent study in patients with node-positive or high-risk node-negative HER2-positive, operable breast cancer to receive either pertuzumab or placebo added to standard adjuvant chemotherapy plus 1 year of treatment with trastuzumab. Pertuzumab significantly improved the rates of invasive-disease–free survival among patients with HER2-positive, operable breast cancer when it was added to trastuzumab and chemotherapy.
SANDRINE RICHARD et al, Pertuzumab and trastuzumab: the rationale way to synergy.An. Acad. Bras. Ciênc. vol.88 supl.1 Rio de Janeiro 2016
Gianni L et al. 2012. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 13(1): 25-32.
NCCN Breast Cancer 2017
Systemic treatment for HER2-positive metastatic breast cancer. Anne F Schott, MD. UpToDate, May 09, 2017
Gunter von Minckwitz, M.D., Marion Procter, Ph.D., Evandro de Azambuja, M.D., Dimitrios Zardavas, M.D., Mark Benyunes, M.D., Giuseppe Viale, M.D., Thomas Suter, M.D., Amal Arahmani, Ph.D., Nathalie Rouchet, M.Sc., Emma Clark, M.Sc., Adam Knott, Ph.D., Istvan Lang, M.D., et al., for the APHINITY Steering Committee and Investigators, Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer. N Engl J Med 2017; 377:122-131
K. Miller, Questioning Our APHINITY for More. N Engl J Med 2017; 377:186-187