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?
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Kimberly L Blackwell, MD |
| Professor of Medicine Director, Breast Cancer Program Duke Cancer Institute Durham, North Carolina |
I would use pertuzumab most or all of the time with trastuzumab/chemotherapy in the neoadjuvant setting, considering the efficacy data and minimal toxicity.
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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 |
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.
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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 |
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.
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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 |
I would administer pertuzumab in combination with trastuzumab/chemotherapy some of the time in the neoadjuvant setting.
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Ian E Krop, MD, PhD |
| Associate Physician Dana-Farber Cancer Institute Assistant Professor of Medicine Harvard Medical School Boston, Massachusetts |
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.
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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 |
I would use pertuzumab in combination with trastuzumab/chemotherapy most of the time in the neoadjuvant setting.
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Joyce O’Shaughnessy, MD |
| Co-Director Breast Cancer Research Program Baylor-Charles A Sammons Cancer Center Texas Oncology US Oncology Dallas, Texas |
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.
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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 |
In the neoadjuvant setting, I would use pertuzumab in combination with trastuzumab/chemotherapy most or all of the time.