How often would you use pertuzumab combined w/ trastuzumab/chemo in the neoadjuvant setting?


How often would you use pertuzumab combined w/ trastuzumab/chemo in the neoadjuvant setting?

With approval of pertuzumab in the neoadjuvant setting, how often do you think you would use it in combination with trastuzumab/chemotherapy when using neoadjuvant treatment for HER2-positive disease?

Kimberly L Blackwell, MD
Professor of Medicine
Director, Breast Cancer Program
Duke Cancer Institute
Durham, North Carolina
Answer: Most or all the time

I would use pertuzumab most or all of the time with trastuzumab/chemotherapy in the neoadjuvant setting, considering the efficacy data and minimal toxicity.

Lisa A Carey, MD
Richardson and Marilyn Jacobs Preyer
Distinguished Professor for
Breast Cancer Research
Chief, Division of Hematology
and Oncology
Physician-in-Chief
North Carolina Cancer Hospital
Associate Director for
Clinical Research
Lineberger Comprehensive
Cancer Center
Chapel Hill, North Carolina
Answer: Sometimes

I would use it in combination with trastuzumab/chemotherapy some of the time. We don't have clinically meaningful endpoints for dual HER2 targeting in the early setting, so I would probably consider it for patients at high risk — for example, with Stage III disease. The data suggest that longer duration matters, so my concern is that any benefit is unlikely to be realized. The only data supporting the idea that HER2 targeting improves event-free survival is from the NOAH trial, in which patients received trastuzumab both during chemotherapy and adjuvantly for a total of 1 year.

Julie R Gralow, MD
Professor, Medical Oncology
Jill Bennett Endowed Professorship in Breast Cancer
University of Washington
School of Medicine
Director, Breast Medical Oncology
University of Washington School of
Medicine/Seattle Cancer Care Alliance
Member, Clinical Research Division
Fred Hutchinson Cancer
Research Center
Seattle, Washington
Answer: Most or all the time

I would recommend pertuzumab in the neoadjuvant setting most or all the time if I had access to it. I administer chemotherapy/trastuzumab preoperatively only to patients at higher risk. It would be useful to have information on which tumors would benefit from dual HER2-targeted therapy and which require only trastuzumab. I have great concerns about the cost of therapy.

Clifford Hudis, MD
Chief, Breast Cancer Medicine Service
Solid Tumor Division
Department of Medicine
Memorial Sloan-Kettering
Cancer Center
Professor of Medicine
Weill Cornell Medical College
New York, New York
Answer: Sometimes

I would administer pertuzumab in combination with trastuzumab/chemotherapy some of the time in the neoadjuvant setting.

Ian E Krop, MD, PhD
Associate Physician
Dana-Farber Cancer Institute
Assistant Professor of Medicine
Harvard Medical School
Boston, Massachusetts
Answer: Most of the time

I would recommend pertuzumab in the neoadjuvant setting most of the time. I believe it is appropriate to use this agent as part of a neoadjuvant chemotherapy/trastuzumab regimen for patients with higher-risk HER2-positive disease. While the FDA indication for pertuzumab is fairly broad (T2 or node-positive), I don’t feel that it is necessary for all patients who fit these criteria because many of those patients who are at lower risk (eg, 2.1-cm tumor, node-negative) will fare well with trastuzumab-based chemotherapy, and we don’t yet know whether pertuzumab improves long-term outcomes.

Kathy D Miller, MD
Co-Director, IU Simon Cancer Center Breast Cancer Team
Ballvé Lantero Scholar in Oncology
Associate Professor of Medicine
Department of Personalized Medicine
Division of Hematology/Oncology
The Indiana University Melvin and Bren Simon Cancer Center
Indianapolis, Indiana
Answer: Most or all the time

I would use pertuzumab in combination with trastuzumab/chemotherapy most of the time in the neoadjuvant setting.

Joyce O’Shaughnessy, MD
Co-Director
Breast Cancer Research Program
Baylor-Charles A Sammons
Cancer Center
Texas Oncology
US Oncology
Dallas, Texas
Answer: Most or all the time

I would use it most of the time in combination with trastuzumab/chemotherapy. The pCR rates are of high importance in ER-negative, HER2-positive disease, and pertuzumab clearly increases the rate for these patients. Patients with luminal B HER2-positive breast cancer also have improved outcomes when they achieve pCR, so pertuzumab will be of benefit to those patients also.

Hope S Rugo, MD
Professor of Medicine
Director
Breast Oncology and
Clinical Trials Education
University of California, San Francisco
Helen Diller Family Comprehensive
Cancer Center
San Francisco, California
Answer: Most or all the time

In the neoadjuvant setting, I would use pertuzumab in combination with trastuzumab/chemotherapy most or all of the time.