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Are there situations in which you would use T-DM1 combined with pertuzumab outside of a trial?

If a patient had not received pertuzumab in the first-line setting, would you use it in the second line or beyond? If so, in what situations would you use it?

Baselga J. T-DM1 mechanism of action and the Phase III MARIANNE trial of T-DM1, T-DM1/pertuzumab or trastuzumab/taxane for HER2-positive mBC. Breast Cancer Update, Issue 2, 2013. Available at http://www.researchtopractice.com/browse-by-tumor-types/breast-cancer/5jcbe/12/2/jose%CC%81-baselga-md-phd/t-dm1-mechanism-action-and-phase.

Chung C, Lam MS. Pertuzumab for the treatment of human epidermal growth factor receptor type 2-positive metastatic breast cancer. Am J Health Syst Pharm 2013;70(18):1579-87. Abstract

DiƩras V et al. A Phase Ib/II trial of trastuzumab-DM1 with pertuzumab for patients with HER2-positive, locally advanced or metastatic breast cancer: Interim efficacy and safety results. San Antonio Breast Cancer Symposium 2010;Abstract P3-14-01.

Krop I, Winer EP. Trastuzumab emtansine: A novel antibody-drug conjugate for HER2-positive breast cancer. Clin Cancer Res 2013;[Epub ahead of print]. Abstract

Lewis Phillips GD et al. Dual targeting of HER2-positive cancer with trastuzumab-emtansine (T-DM1) and pertuzumab: Critical role for neuregulin blockade in anti-tumor response to combination therapy. Clin Cancer Res 2013;[Epub ahead of print]. Abstract

MARIANNE: A study of trastuzumab-DM1 plus pertuzumab versus trastuzumab [Herceptin] plus a taxane in patients with metastatic breast cancer. NCT01120184

Swain SM et al. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA study): Overall survival results from a randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol 2013;14(6):461-71. Abstract

Verma S et al. Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med 2012;367(19):1783-91. Abstract

Welslau M et al. Patient-reported outcomes from EMILIA, a randomized phase 3 study of trastuzumab emtansine (T-DM1) versus capecitabine and lapatinib in human epidermal growth factor receptor 2-positive locally advanced or metastatic breast cancer. Cancer 2013;[Epub ahead of print]. Abstract