Vikram C. Gorantla, MD, clinical assistant professor, UPMC Hillman Cancer Center, addresses the unanswered questions following the APHINITY trial in HER2-positive breast cancer.

Findings from the APHINITY trial led to the 2017 FDA approval of pertuzumab (Perjeta) in combination with trastuzumab (Herceptin) and chemotherapy as an adjuvant treatment for patients with HER2-positive breast cancer who are at high risk for recurrence. The overall survival data from this trial are still maturing, which means that questions remain.

Gorantla raises the question of managing patients with residual disease. Additionally, he asks, what should be done for patients who received neoadjuvant therapy with docetaxel, carboplatin, trastuzumab, and pertuzumab?

Long-term implications also need to be considered, as well as the cost of therapy. Cost involves not only physical and emotional toxicities, Gorantla explains, but also financial toxicities. That is something that is being closely examined now. As for physical toxicities, the biggest issue with pertuzumab was the rate of diarrhea—approximately a 7% increase compared with trastuzumab alone&mdash;but it can be easily managed, Gorantla says.

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Vikram C. Gorantla, MD, clinical assistant professor, UPMC Hillman Cancer Center, addresses the unanswered questions following the APHINITY trial in HER2-positive breast cancer.
 

Dr. Gorantla Addresses Unanswered Questions From the APHINITY Trial

Vikram C. Gorantla, MD, clinical assistant professor, UPMC Hillman Cancer Center, discusses the impact of the APHINITY trial on the treatment of patients with HER2-positive breast cancer.

Trastuzumab (Herceptin) was a game-changer for patients with HER2-positive breast cancer, says Gorantla, and the field has seen much success since the introduction of the agent. As pertuzumab (Perjeta) is approved in the neoadjuvant setting, it seemed logical to see if it would be effective in the adjuvant setting. Adding pertuzumab to trastuzumab in the adjuvant setting was done in an effort to improve outcomes even further, Gorantla explains.

The APHINITY trial showed that adjuvant treatment with pertuzumab, trastuzumab, and chemotherapy elicited a 3-year invasive disease-free survival rate of 94.1% versus 93.2% for patients with HER2-positive early breast cancer who received trastuzumab plus chemotherapy and placebo. These findings led to the December 2017 FDA approval of the regimen for this population. Gorantla says that benefit was seen largely in node-positive patients, as well as estrogen receptor—negative and progesterone receptor–negative patients. This is where the regimen will most likely be used, he concludes.

Vikram C. Gorantla, MD, clinical assistant professor, UPMC Hillman Cancer Center, discusses the impact of the APHINITY trial on the treatment of patients with HER2-positive breast cancer.
 

Vikram C. Gorantla, MD

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