Dr. Gorantla Addresses Unanswered Questions From the APHINITY Trial

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—but it can be easily managed, Gorantla says.