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Ma F, Yan M, Li W, Ouyang Q, Tong Z, Teng Y, Wang Y, Wang S, Geng C, Luo T, Zhong J, Zhang Q, Liu Q, Zeng X, Sun T, Mo Q, Liu H, Cheng Y, Cheng J, Wang X, Nie J, Yang J, Wu X, Wang X, Li H, Ye C, Dong F, Wu S, Zhu X, Xu B. Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): randomised, double blind, multicentre, phase 3 trial. BMJ 2023; 383:e076065. [PMID: 37907210 PMCID: PMC10616786 DOI: 10.1136/bmj-2023-076065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of pyrotinib (an irreversible pan-HER (human epidermal growth factor receptor) inhibitor), trastuzumab, and docetaxel compared with placebo, trastuzumab, and docetaxel for untreated HER2 positive metastatic breast cancer. DESIGN Randomised, double blind, placebo controlled, multicentre, phase 3 trial. SETTING 40 centres in China between 6 May 2019 and 17 January 2022. PARTICIPANTS 590 female patients (median age 52 (interquartile range 46-58) years) with untreated HER2 positive metastatic breast cancer. INTERVENTIONS Eligible patients were randomised 1:1 to receive either oral pyrotinib (400 mg once daily) or placebo, both combined with intravenous trastuzumab (8 mg/kg in cycle 1 and 6 mg/kg in subsequent cycles) and docetaxel (75 mg/m2) on day 1 of each 21 day cycle. Randomisation was stratified by treatment history of trastuzumab in the (neo)adjuvant setting and hormone receptor status. Patients, investigators, and the sponsor's study team were masked to treatment assignment. MAIN OUTCOME MEASURES The primary endpoint was progression-free survival as assessed by the investigator. RESULTS Of the 590 randomised patients, 297 received pyrotinib, trastuzumab, and docetaxel treatment (pyrotinib group), and 293 received placebo, trastuzumab, and docetaxel treatment (placebo group). At data cut-off on 25 May 2022, the median follow-up was 15.5 months. The median progression-free survival according to the investigator was significantly longer in the pyrotinib group than in the placebo group (24.3 (95% confidence interval 19.1 to 33.0) months versus 10.4 (9.3 to 12.3) months; hazard ratio 0.41 (95% confidence interval 0.32 to 0.53); one sided P<0.001). Treatment related adverse events of grade 3 or higher were reported in 267 (90%) of the 297 patients in the pyrotinib group and 224 (76%) of the 293 patients in the placebo group. No treatment related deaths occurred in the pyrotinib group, and one (<1%; diabetic hyperosmolar coma) treatment related death occurred in the placebo group. Survival and toxicities are still under assessment with longer follow-up. CONCLUSIONS Pyrotinib, trastuzumab, and docetaxel showed superiority by significantly improving progression-free survival compared with placebo, trastuzumab, and docetaxel in patients with untreated HER2 positive metastatic breast cancer. The toxicity was manageable. The findings support this dual anti-HER2 regimen as an alternative first line treatment option in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT03863223.
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Affiliation(s)
- Fei Ma
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Yan
- Department of Breast Disease, Henan Breast Cancer Center, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wei Li
- Department of Oncology, The First Hospital of Jilin University, Changchun, China
| | - Quchang Ouyang
- Breast Internal Medicine Department, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhongsheng Tong
- Department of Breast Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Yuee Teng
- Department of Breast Internal Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yongsheng Wang
- Breast Surgery, Shandong Cancer Hospital and Institute, Jinan, China
| | - Shusen Wang
- Department of Internal Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Cuizhi Geng
- Breast Center, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, Shijiazhuang, China
| | - Ting Luo
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jincai Zhong
- Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingyuan Zhang
- Ward One of Mammary Department, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Liu
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohua Zeng
- Breast Cancer Center, Affiliated Cancer Hospital of Chongqing University, Chongqing, China
| | - Tao Sun
- Breast Internal Medicine Department, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Qinguo Mo
- Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Hu Liu
- Department of Medical Oncology, The First Affiliated Hospital of USTC West District, Hefei, China
| | - Ying Cheng
- Department of Thoracic Oncology, Jilin Cancer Hospital, Changchun, China
| | - Jing Cheng
- Oncology Center Breast Department, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaojia Wang
- Breast Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jianyun Nie
- Breast Surgery, Yunnan Cancer Hospital, Kunming, China
| | - Jin Yang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinhong Wu
- Department of Breast Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Xinshuai Wang
- Department of Medical Oncology, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Changsheng Ye
- Department of Breast, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Fangli Dong
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Shuchao Wu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Binghe Xu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Martino BR, Mank V, Mignano S, Neubert Z. A Unique Endoscopic Presentation of Colon Metastases From Primary Invasive Lobular Carcinoma of the Breast. Cureus 2023; 15:e37896. [PMID: 37213975 PMCID: PMC10199746 DOI: 10.7759/cureus.37896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Breast cancer is the leading cause of female malignancy-associated death worldwide. The most common sites of metastases are the lung, liver, brain, and skeleton. A 68-year-old female with invasive lobular carcinoma metastatic to the axial skeleton was found to have new skin and colonic metastases discovered on serial surveillance positron emission tomography-computed tomography scans. The colonic metastases did not present with any gastrointestinal symptoms and did not form exophytic masses, which are typically associated. Instead, her colonic metastases presented as unusual diaphragm-like strictures within the left colon discovered on endoscopy, which is a relatively rare phenomenon. This case raises awareness of and elucidates new manners of presentation of metastatic invasive lobular carcinoma within the colon.
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Affiliation(s)
- Brendan R Martino
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, USA
| | - Victoria Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, USA
| | | | - Zachary Neubert
- Department of Gastroenterology, Tripler Army Medical Center, Honolulu, USA
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Pohlmann PR, Graham D, Wu T, Ottaviano Y, Mohebtash M, Kurian S, McNamara D, Lynce F, Warren R, Dilawari A, Rao S, Mainor C, Swanson N, Tan M, Isaacs C, Swain SM. HALT-D: a randomized open-label phase II study of crofelemer for the prevention of chemotherapy-induced diarrhea in patients with HER2-positive breast cancer receiving trastuzumab, pertuzumab, and a taxane. Breast Cancer Res Treat 2022; 196:571-581. [PMID: 36280642 PMCID: PMC9633499 DOI: 10.1007/s10549-022-06743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess whether crofelemer would prevent chemotherapy-induced diarrhea (CID) diarrhea in patients with HER2-positive, any-stage breast cancer receiving trastuzumab (H), pertuzumab (P), and a taxane (T; docetaxel or paclitaxel), with/without carboplatin (C; always combined with docetaxel rather than paclitaxel). METHODS Patients scheduled to receive ≥ 3 consecutive TCHP/THP cycles were randomized to crofelemer 125 mg orally twice daily during chemotherapy cycles 1 and 2 or no scheduled prophylactic medication (control). All received standard breakthrough antidiarrheal medication (BTAD) as needed. The primary endpoint was incidence of any-grade CID for ≥ 2 consecutive days. Secondary endpoints were incidence of all-grade and grade 3/4 CID by cycle/stratum; time to onset and duration of CID; stool consistency; use of BTAD; and quality of life (Functional Assessment of Chronic Illness Therapy for Patients With Diarrhea [FACIT-D] score). RESULTS Fifty-one patients were randomized to crofelemer (n = 26) or control (n = 25). There was no statistically significant difference between arms for the primary endpoint; however, incidence of grade ≥ 2 CID was reduced with crofelemer vs control (19.2% vs 24.0% in cycle 1; 8.0% vs 39.1%, in cycle 2). Patients receiving crofelemer were 1.8 times more likely to see their diarrhea resolved and had less frequent watery diarrhea. CONCLUSION Despite the choice of primary endpoint being insensitive, crofelemer reduced the incidence and severity of CID in patients with HER2-positive breast cancer receiving P-based therapy. These data are supportive of further testing of crofelemer in CID. TRIAL REGISTRATION Clinicaltrials.gov, NCT02910219, prospectively registered September 21, 2016.
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Affiliation(s)
- Paula R Pohlmann
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deena Graham
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - Tianmin Wu
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Shweta Kurian
- Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Donna McNamara
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Robert Warren
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Asma Dilawari
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
- FDA Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Suman Rao
- Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Candace Mainor
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- MedStar Georgetown University Hospital, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Nicole Swanson
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Ming Tan
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Clinical Research Management Office, Georgetown University Medical Center, Washington, DC, USA
| | - Sandra M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
- MedStar Health, Washington, DC, USA.
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Nozawa K, Takatsuka D, Endo Y, Horisawa N, Ozaki Y, Kataoka A, Kotani H, Yoshimura A, Hattori M, Sawaki M, Iwata H. Triple HER2-blockade with lapatinib, trastuzumab, and pertuzumab for treatment of HER2 positive metastatic breast cancer with lymphangitic carcinomatosis: A case study. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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5
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Gan HK, Millward M, Jalving M, Garrido-Laguna I, Lickliter JD, Schellens JHM, Lolkema MP, Van Herpen CLM, Hug B, Tang L, O'Connor-Semmes R, Gagnon R, Ellis C, Ganji G, Matheny C, Drilon A. A Phase I, First-in-Human Study of GSK2849330, an Anti-HER3 Monoclonal Antibody, in HER3-Expressing Solid Tumors. Oncologist 2021; 26:e1844-e1853. [PMID: 34132450 PMCID: PMC8488777 DOI: 10.1002/onco.13860] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND GSK2849330, an anti-HER3 monoclonal antibody that blocks HER3/Neuregulin 1 (NRG1) signaling in cancer cells, is engineered for enhanced antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. This phase I, first-in-human, open-label study assessed the safety, pharmacokinetics (PK), pharmacodynamics, and preliminary activity of GSK2849330 in patients with HER3-expressing advanced solid tumors. PATIENTS AND METHODS Patients with various tumor types were prospectively selected for HER3 expression by immunohistochemistry; a subset was also screened for NRG1 mRNA expression. In the dose-escalation phase, patients received GSK2849330 1.4-30 mg/kg every 2 weeks, or 3 mg/kg or 30 mg/kg weekly, intravenously (IV). In the dose-expansion phase, patients received 30 mg/kg GSK2849330 IV weekly. RESULTS Twenty-nine patients with HER3-expressing cancers, of whom two expressed NRG1, received GSK2849330 (dose escalation: n = 18, dose expansion: n = 11). GSK2849330 was well tolerated. No dose-limiting toxicities were observed. The highest dose, of 30 mg/kg weekly, expected to provide full target engagement, was selected for dose expansion. Treatment-emergent adverse events (AEs) were mostly grade 1 or 2. The most common AEs were diarrhea (66%), fatigue (62%), and decreased appetite (31%). Dose-proportional plasma exposures were achieved, with evidence of HER3 inhibition in paired tissue biopsies. Of 29 patients, only 1 confirmed partial response, lasting 19 months, was noted in a patient with CD74-NRG1-rearranged non-small cell lung cancer (NSCLC). CONCLUSION GSK2849330 demonstrated a favorable safety profile, dose-proportional PK, and evidence of target engagement, but limited antitumor activity in HER3-expressing cancers. The exceptional response seen in a patient with CD74-NRG1-rearranged NSCLC suggests further exploration in NRG1-fusion-positive cancers. IMPLICATIONS FOR PRACTICE This first-in-human study confirms that GSK2849330 is well tolerated. Importantly, across a variety of HER3-expressing advanced tumors, prospective selection by HER3/NRG1 expression alone was insufficient to identify patients who could benefit from treatment with this antibody-dependent cell-mediated cytotoxicity- and complement-dependent cytotoxicity-enhanced anti-HER3 antibody. The only confirmed durable response achieved was in a patient with CD74-NRG1-rearranged lung cancer. This highlights the potential utility of screening for NRG1 fusions prospectively across tumor types to enrich potential responders to anti-HER3 agents in ongoing trials.
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Affiliation(s)
- Hui K Gan
- Department of Medical Oncology, Austin Health and Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Medicine, Latrobe University School of Cancer Medicine, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne University, Melbourne, Victoria, Australia
| | - Michael Millward
- Linear Clinical Research and University of Western Australia, Perth, Western Australia, Australia
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ignacio Garrido-Laguna
- Department of Internal Medicine, Oncology Division, University of Utah School of Medicine, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Jan H M Schellens
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Carla L M Van Herpen
- Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Bruce Hug
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Lihua Tang
- Independent Consultant, North Carolina, USA
| | - Robin O'Connor-Semmes
- Clinical Pharmacology, Modeling and Simulation, Parexel International, Durham, North Carolina, USA
| | | | | | | | | | - Alexander Drilon
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
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Jagosky M, Tan AR. Combination of Pertuzumab and Trastuzumab in the Treatment of HER2-Positive Early Breast Cancer: A Review of the Emerging Clinical Data. BREAST CANCER-TARGETS AND THERAPY 2021; 13:393-407. [PMID: 34163239 PMCID: PMC8213954 DOI: 10.2147/bctt.s176514] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/23/2021] [Indexed: 01/03/2023]
Abstract
Human epidermal growth factor receptor type 2 (HER2) is a relevant and effective target in breast cancer. The development of monoclonal antibodies against HER2 has revolutionized the treatment of HER2-positive breast cancer. The humanized monoclonal antibody, trastuzumab, was the first in its class to be widely adopted. It was initially studied in the metastatic setting and then in the treatment of early-stage disease, demonstrating significant improvement in overall survival in both settings. The addition of pertuzumab further improved upon results achieved with trastuzumab and chemotherapy, specifically extending overall survival in patients with metastatic disease, lessening the risk of recurrence when used in the adjuvant setting, and improving pathologic complete response rate when utilized in the neoadjuvant setting. In this article, we review the studies that support the use of HER2-directed monoclonal antibodies in early-stage breast cancer both in the adjuvant and neoadjuvant settings and focus on the success of dual HER2-targeted therapy achieved with the combination of trastuzumab and pertuzumab. A newer way to administer these agents, specifically the subcutaneous formulation of pertuzumab and trastuzumab with recombinant human hyaluronidase, will also be discussed.
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Affiliation(s)
- Megan Jagosky
- Department of Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Antoinette R Tan
- Department of Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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7
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R Ferreira A, Ferreira S, Lambertini M, Maurer C, Martel S, Costa L, Ponde N, de Azambuja E. Association between pertuzumab-associated diarrhoea and rash and survival outcomes in patients with HER2-positive metastatic breast cancer: Exploratory analysis from the CLEOPATRA trial. Eur J Cancer 2021; 144:351-359. [PMID: 33388492 DOI: 10.1016/j.ejca.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin rash and diarrhoea are known side-effects of pertuzumab. Studies with other anti-HER2 agents suggested that adverse events correlate with patient outcomes. In this exploratory cohort of patients with metastatic HER2-positive breast cancer included in the CLEOPATRA trial we evaluated the value of rash and diarrhoea as prognostic markers and as predictors of pertuzumab benefit. METHODS This is a retrospective analysis of the multicenter, prospective, randomised CLEOPATRA trial. We defined two analytic cohorts: cohort 1 (C1) included patients from treatment initiation, and cohort 2 (C2) included patients after discontinuation of docetaxel. A landmark analysis was introduced to deal with immortal-time bias. Study endpoints were progression-free survival (PFS) and overall survival (OS). Univariable and multivariable Cox proportional hazards models were used. RESULTS Of the 808 patients and after application of the landmark analysis, C1 and C2 included 777 and 518 patients, respectively. In C1, rash occurred in 271 patients (34.9%) and diarrhoea in 470 (60.5%). Rash was prognostic for PFS and OS (C1: adjusted hazard ratio [aHR] = 0.66 [95% CI = 0.48-0.91], p = 0.010]; C2: aHR 0.52 [95% CI = 0.30-0.89], p = 0.018) in both cohorts, while diarrhoea was only prognostic for PFS in cohort 2 (aHR = 0.65 [95% CI = 0.46-0.91], p = 0.011). Rash and diarrhoea were not predictive of pertuzumab benefit (in terms of PFS/OS) in the two cohorts. CONCLUSIONS In patients treated with pertuzumab, trastuzumab, and docetaxel, rash is prognostic whenever it occurs during treatment, while diarrhoea only has prognostic value when occurring after docetaxel discontinuation. However, neither rash nor diarrhoea predict pertuzumab benefit.
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Affiliation(s)
- Arlindo R Ferreira
- Institut Jules Bordet, L'Université Libre de Bruxelles (U.L.B), Belgium; Hospital de Santa Maria and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Portugal
| | - Sofia Ferreira
- Institut Jules Bordet, L'Université Libre de Bruxelles (U.L.B), Belgium; Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Matteo Lambertini
- Institut Jules Bordet, L'Université Libre de Bruxelles (U.L.B), Belgium; IRCCS Ospedale Policlinico San Martino, Genova, Italy; University of Genova, Genova, Italy
| | - Christian Maurer
- Institut Jules Bordet, L'Université Libre de Bruxelles (U.L.B), Belgium; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and University of Cologne, Germany
| | - Samuel Martel
- Institut Jules Bordet, L'Université Libre de Bruxelles (U.L.B), Belgium; CISSS Montérégie-centre/Hôpital Charles-Lemoyne, Canada
| | - Luis Costa
- Hospital de Santa Maria and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Noam Ponde
- Institut Jules Bordet, L'Université Libre de Bruxelles (U.L.B), Belgium; AC Carmargo Cancer Center, São Paulo, Brazil
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Lv M, Guo H, Wang C, Tian P, Ma Y, Chen X, Luo S. Neoadjuvant docetaxel with or without carboplatin plus dual HER2 blockade for HER2-positive breast cancer: a retrospective multi-center Chinese study. Gland Surg 2020; 9:2079-2090. [PMID: 33447559 DOI: 10.21037/gs-20-791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background This study aimed to compare the real-world efficacy and safety of the TCbHP regimen (docetaxel, carboplatin, trastuzumab and pertuzumab) and the THP regimen (docetaxel, trastuzumab and pertuzumab) as neoadjuvant therapy for Chinese patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Methods We compared efficacy and safety outcomes from 72 Chinese patients with HER2-positive breast cancer who underwent neoadjuvant dual HER2 blockade plus TCb or T chemotherapy and surgery between March 2019 and June 2020. Results All 72 patients were women (32-76 years old) and the overall pathological complete response (pCR) rate was 70.8% (51/72). The pCR rates were 76.1% (35/46) for the TCbHP regimen and 61.5% (16/26) for the THP regimen (P=0.28). Univariate analyses revealed that pCR was associated with clinical T classification (P=0.024), AJCC stage (P=0.042), estrogen receptor (ER) status (P=0.002), progesterone receptor (PR) status (P=0.035), Ki-67 index (P<0.001), and immunohistochemical HER2 status (P<0.001). Multivariate analyses revealed that pCR was independently predicted by ER status (OR: 0.227, 95% CI: 0.053-0.852; P=0.032) and immunohistochemical HER2 status (OR: 43.673, 95% CI: 6.801-875.86; P<0.001). The common adverse events for both regimens included neutropenia, anemia, thrombocytopenia, nausea, and diarrhea. Relative to the THP group, the TCbHP group had higher frequencies of grade 3-4 thrombocytopenia (17% vs. 0%, P=0.044) and grade 3-4 diarrhea (15% vs. 0%, P=0.044). Both regimens had very good cardiac safety. Conclusions These results suggest that both TCbHP and THP regimens may be useful neoadjuvant treatments for high-risk early or locally advanced HER2-positive breast cancer. Both regimens had generally good safety outcomes, although clinicians should be aware of the risks of grade 3-4 thrombocytopenia and diarrhea during TCbHP treatment. Elderly patients who require neoadjuvant therapy may benefit from 6 cycles of THP treatment, based on its good efficacy and mild adverse events.
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Affiliation(s)
- Minhao Lv
- Department of Breast Disease, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Huihui Guo
- Department of General Surgery, The Jiyuan People's Hospital, Jiyuan, China
| | - Chao Wang
- Department of General Surgery, The Huaxian People's Hospital, Huaxian, China
| | - Peiqi Tian
- Department of Breast Disease, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Youzhao Ma
- Department of Breast Disease, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xiuchun Chen
- Department of Breast Disease, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Suxia Luo
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Pondé N, Wildiers H, Awada A, de Azambuja E, Deliens C, Lago LD. Targeted therapy for breast cancer in older patients. J Geriatr Oncol 2020; 11:380-388. [DOI: 10.1016/j.jgo.2019.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/25/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022]
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10
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Stroes CI, Schokker S, Creemers A, Molenaar RJ, Hulshof MCCM, van der Woude SO, Bennink RJ, Mathôt RAA, Krishnadath KK, Punt CJA, Verhoeven RHA, van Oijen MGH, Creemers GJ, Nieuwenhuijzen GAP, van der Sangen MJC, Beerepoot LV, Heisterkamp J, Los M, Slingerland M, Cats A, Hospers GAP, Bijlsma MF, van Berge Henegouwen MI, Meijer SL, van Laarhoven HWM. Phase II Feasibility and Biomarker Study of Neoadjuvant Trastuzumab and Pertuzumab With Chemoradiotherapy for Resectable Human Epidermal Growth Factor Receptor 2-Positive Esophageal Adenocarcinoma: TRAP Study. J Clin Oncol 2019; 38:462-471. [PMID: 31809243 DOI: 10.1200/jco.19.01814] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Approximately 15% to 43% of esophageal adenocarcinomas (EACs) are human epidermal growth factor receptor 2 (HER2) positive. Because dual-agent HER2 blockade demonstrated a survival benefit in breast cancer, we conducted a phase II feasibility study of trastuzumab and pertuzumab added to neoadjuvant chemoradiotherapy (nCRT) in patients with EAC. PATIENTS AND METHODS Patients with resectable HER2-positive EAC received standard nCRT with carboplatin and paclitaxel and 41.4 Gy of radiotherapy, with 4 mg/kg of trastuzumab on day 1, 2 mg/kg per week during weeks 2 to 6, and 6 mg/kg per week during weeks 7, 10, and 13 and 840 mg of pertuzumab every 3 weeks. The primary end point was feasibility, defined as ≥ 80% completion of treatment with both trastuzumab and pertuzumab. An exploratory comparison of survival with a propensity score-matched cohort receiving standard nCRT was performed, as were exploratory pharmacokinetic and biomarker analyses. RESULTS Of the 40 enrolled patients (78% men; median age, 63 years), 33 (83%) completed treatment with trastuzumab and pertuzumab. No unexpected safety events were observed. R0 resection was achieved in all patients undergoing surgery, with pathologic complete response in 13 patients (34%). Three-year progression-free and overall survival (OS) were 57% and 71%, respectively (median follow-up, 32.1 months). Compared with the propensity score-matched cohort, a significantly longer OS was observed with HER2 blockade (hazard ratio, 0.58; 95% CI, 0.34 to 0.97). Results of pharmacokinetic analysis and activity on [18F]fluorodeoxyglucose positron emission tomography scans did not correlate with survival or pathologic response. Patients with HER2 3+ overexpression or growth factor receptor-bound protein 7 (Grb7) -positive tumors at baseline demonstrated significantly better survival (P = .007) or treatment response (P = .016), respectively. CONCLUSION Addition of trastuzumab and pertuzumab to nCRT in patients with HER2-positive EAC is feasible and demonstrates potentially promising activity compared with historical controls. HER2 3+ overexpression and Grb7 positivity are potentially predictive for survival and treatment response, respectively.
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Affiliation(s)
- Charlotte I Stroes
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sandor Schokker
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Aafke Creemers
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Remco J Molenaar
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Stephanie O van der Woude
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Roel J Bennink
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ron A A Mathôt
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Kausilia K Krishnadath
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J A Punt
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rob H A Verhoeven
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Martijn G H van Oijen
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | - Maartje Los
- Sint Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Annemieke Cats
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Maarten F Bijlsma
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sybren L Meijer
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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11
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Ishii K, Morii N, Yamashiro H. Pertuzumab in the treatment of HER2-positive breast cancer: an evidence-based review of its safety, efficacy, and place in therapy. CORE EVIDENCE 2019; 14:51-70. [PMID: 31802990 PMCID: PMC6827570 DOI: 10.2147/ce.s217848] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 12/23/2022]
Abstract
Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is a distinct subset of breast cancer that results from overexpression of HER2 protein. Pertuzumab-a recombinant humanized monoclonal antibody that binds to the extracellular dimerization domain II of HER2-was recently approved for adjuvant therapy and neoadjuvant therapy of HER2-positive early breast cancer. As pertuzumab and trastuzumab bind to different domains of the extracellular dimerization domain of HER2, a combination therapy of pertuzumab and trastuzumab is beneficial for the treatment of metastatic cancer, advanced local cancer, or early cancer by dual HER2 blockage. Many clinical trials have been performed using pertuzumab for breast cancer patients; these include the CLEOPATRA trial for palliative therapy, the APHINITY trial for adjuvant therapy, and the NeoSphere and the TRYPHAENA trials for neoadjuvant therapy. These trials revealed pertuzumab to be a safe and effective drug regardless of the patient age and hormone receptor status. Notably, pertuzumab use was associated with severe cardiac toxicity in some cases; however, the risk of pertuzumab-induced cardiac dysfunction was low. The most common adverse effect associated with pertuzumab-use was diarrhea, but most cases were not severe. Several different chemotherapeutic agents have been investigated to determine optimal chemotherapeutic combinations for dual HER2 blockage. Some exploratory analyses indicate that pertuzumab treatment offered little benefit to patients with node-negative and small primary tumors; pertuzumab treatment was also found not be cost-effective. Further research will reveal the appropriate usage of pertuzumab for treating a subset of eligible patients.
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Affiliation(s)
- Kei Ishii
- Department of Breast Surgery, Tenri Hospital, Tenri, Japan
| | - Nao Morii
- Department of Breast Surgery, Tenri Hospital, Tenri, Japan
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12
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Yankulina O, Zullo AR, Cabral SE, Huynh JP, Hutchinson JA, Lopresti ML, Fenton MA, Berard-Collins CM. Pertuzumab-associated diarrhea in HER2/neu-positive breast cancer patients: A comparison of trials to actual practice. J Oncol Pharm Pract 2019; 26:912-917. [PMID: 31631811 DOI: 10.1177/1078155219879211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although landmark trials in the metastatic (CLEOPATRA) and neo-adjuvant (NeoSphere; TRYPHAENA) settings identified all-grade diarrhea as a pertuzumab-associated adverse event, it was not classified as dose-limiting. In actual practice, diarrhea is often a reason for treatment modifications. OBJECTIVES To compare the risk of pertuzumab-associated diarrhea in actual practice to the risks in randomized controlled trials. METHODS We conducted a retrospective cohort study of HER2/neu-positive breast cancer patients who received a pertuzumab-containing regimen between January 2012 and August 2015. We calculated the risk of diarrhea with 95% confidence limits (CLs), and then used two-sample t-tests to compare the risk between trials and actual practice. RESULTS A total of 27 patients in the study cohort received a pertuzumab-containing treatment regimen for HER2/neu-positive breast cancer. The overall risk of all-grade and severe diarrhea in actual practice was 70% (95% CLs 55-90%) and 37% (95% CLs 20-66%), respectively. No severe diarrhea was observed in the metastatic setting, and the risk of all-grade diarrhea (44%, 95% CLs 21-92%) was similar to the CLEOPATRA study (67%). The risk of all-grade diarrhea in the neo-adjuvant setting was 83% (95% CLs 68-100%), compared to 46% in the NeoSphere trial (p = 0.03). The risk of severe diarrhea (Grade 3-4) in the neo-adjuvant setting was 47% (95% CLs 27-80%) versus 6% in the NeoSphere (p < 0.0001) and 12% in the TRYPHAENA (p < 0.01) trials. CONCLUSIONS The risk of all-grade and severe diarrhea associated with neoadjuvant pertuzumab use for HER2/neu-positive breast cancer was greater in actual practice than in trials.
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Affiliation(s)
- Olga Yankulina
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew R Zullo
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA.,Department of Health Services, Policy, and Practice, Brown University, Providence, RI, USA
| | - Sarah E Cabral
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Justin P Huynh
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | | | - Mary L Lopresti
- Department of Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Mary A Fenton
- Department of Oncology, Rhode Island Hospital, Providence, RI, USA
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13
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Incidence and Management of Diarrhea With Adjuvant Pertuzumab and Trastuzumab in Patients With Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer. Clin Breast Cancer 2019; 20:174-181.e3. [PMID: 31924513 DOI: 10.1016/j.clbc.2019.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/19/2019] [Accepted: 06/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The APHINITY (BIG 4-11) study showed that pertuzumab significantly improved the rates of invasive disease-free survival among patients with human epidermal growth factor receptor 2 (HER2)-positive, operable breast cancer when added to adjuvant trastuzumab and chemotherapy. Because diarrhea was a common adverse event that could compromise treatment administration, we evaluated the incidence and management of diarrhea in the APHINITY study. PATIENTS AND METHODS The APHINITY trial is a prospective, randomized, multicenter, multinational, double-blind, placebo-controlled trial. The eligible patients were randomly assigned to receive standard adjuvant chemotherapy and 1 year of trastuzumab combined with pertuzumab or placebo. The diarrhea incidence, severity (National Cancer Institute common terminology criteria for adverse events, version 4.0), onset, and management were analyzed. RESULTS A total of 4805 patients were randomized. Diarrhea of any grade was the most common adverse event and occurred in 71% of patients in the pertuzumab arm versus 45% in the placebo arm. Diarrhea grade 3 to 4 was observed in 10% and 4% in the pertuzumab and placebo arms, respectively. The greatest incidence of diarrhea was reported during the concomitant administration of HER2-targeted therapy and taxane (61% vs. 34% of patients experienced an event with pertuzumab vs. placebo, respectively). A marked decrease was observed on chemotherapy cessation. Antidiarrheal agents were commonly used, and diarrhea rarely caused treatment dose modifications or discontinuation. CONCLUSION Diarrhea was a common adverse event in the APHINITY study. Most episodes were low grade and were generally manageable with common antidiarrheal agents. The incidence of diarrhea was greater with the combination of a taxane and HER2-targeted treatment and decreased once chemotherapy was stopped.
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14
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Choi JDW, Hughes TMD, Marx G, Rutovitz J, Hasovits C, Ngui NK. Pathological outcomes of HER2‐positive non‐metastatic breast cancer patients treated with neoadjuvant dual anti‐HER2 therapy and taxane: An Australian experience. Asia Pac J Clin Oncol 2019; 16:103-107. [DOI: 10.1111/ajco.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/27/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph Do Woong Choi
- Division of SurgerySydney Adventist Hospital Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Thomas Michael D. Hughes
- Division of SurgerySydney Adventist Hospital Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Gavin Marx
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
- Department of Medical OncologySydney Adventist Hospital Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Josie Rutovitz
- Department of Medical OncologySydney Adventist Hospital Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Csilla Hasovits
- Department of Medical OncologySydney Adventist Hospital Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
| | - Nicholas K. Ngui
- Division of SurgerySydney Adventist Hospital Sydney New South Wales Australia
- Sydney Adventist Hospital Clinical SchoolThe University of Sydney Sydney New South Wales Australia
- Breast Multidisciplinary TeamSydney Adventist Hospital Sydney New South Wales Australia
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15
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Mortimer J, Di Palma J, Schmid K, Ye Y, Jahanzeb M. Patterns of occurrence and implications of neratinib-associated diarrhea in patients with HER2-positive breast cancer: analyses from the randomized phase III ExteNET trial. Breast Cancer Res 2019; 21:32. [PMID: 30813966 PMCID: PMC6391844 DOI: 10.1186/s13058-019-1112-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background We characterized patterns of occurrence and the impact of neratinib-associated diarrhea in the absence of protocol-directed antidiarrheal prophylaxis or a formal diarrhea management plan using data from Extended Adjuvant Treatment of Breast Cancer with Neratinib (ExteNET). Methods ExteNET is a multicenter, double-blind, placebo-controlled, randomized phase III trial involving community-based and academic institutions in 40 countries. Women with HER2-positive early-stage breast cancer with prior standard primary therapy and trastuzumab-based (neo)adjuvant therapy were randomized to neratinib 240 mg/day or placebo for 12 months. Safety, a secondary outcome, was assessed using the National Cancer Institute Common Terminology Criteria version 3.0. Health-related quality of life by diarrhea grade was assessed using Functional Assessment of Cancer Therapy-Breast (FACT-B). Results Two thousand eight hundred sixteen women (1408 per group) were safety-evaluable. Grade 3 and 4 diarrhea occurred in 561 (39.8%) and 1 (0.1%) patients with neratinib versus 23 (1.6%) and 0 patients with placebo, respectively. In the neratinib group, 28.6% of patients had grade 3 events during month 1 decreasing to ≤ 6% after month 3. The median cumulative duration of grade 3/4 diarrhea with neratinib was 5 days (interquartile range, 2–9). Serious diarrheal events (n = 22, 1.6%) and diarrheal events requiring hospitalization (n = 20, 1.4%) were rare with neratinib. Changes in FACT-B total score by diarrhea grade in the neratinib group did not meet the threshold for clinically important differences. Conclusions In the absence of antidiarrheal prophylaxis, neratinib-related diarrhea is short-lived and not associated with complications or long-term sequelae. This suggests that targeted preventive management with antidiarrheal prophylaxis early during neratinib treatment is appropriate. Trial registration ClinicalTrials.gov NCT00878709. Registered 9 April 2009. Electronic supplementary material The online version of this article (10.1186/s13058-019-1112-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanne Mortimer
- City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
| | - Jack Di Palma
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Kendra Schmid
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yining Ye
- Puma Biotechnology Inc., South San Francisco, CA, USA.,Present address: QED Therapeutics, San Francisco, CA, USA
| | - Mohammad Jahanzeb
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Deerfield Beach, FL, USA
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16
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Li J. Diarrhea With HER2-Targeted Agents in Cancer Patients: A Systematic Review and Meta-Analysis. J Clin Pharmacol 2019; 59:935-946. [DOI: 10.1002/jcph.1382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/10/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Li
- College of Pharmacy; Southwest Minzu University; Chengdu Sichuan P. R. China
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17
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Kirschbrown WP, Wynne C, Kågedal M, Wada R, Li H, Wang B, Nijem I, Badovinac Crnjevic T, Gasser H, Heeson S, Eng-Wong J, Garg A. Development of a Subcutaneous Fixed-Dose Combination of Pertuzumab and Trastuzumab: Results From the Phase Ib Dose-Finding Study. J Clin Pharmacol 2018; 59:702-716. [PMID: 30570763 PMCID: PMC7027517 DOI: 10.1002/jcph.1362] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
Abstract
Adding pertuzumab to trastuzumab (both monoclonal antibodies targeting human epidermal growth factor receptor 2 [HER2]) has proven survival benefits when combined with chemotherapy for patients with HER2-positive breast cancer. The combination of pertuzumab and trastuzumab together in 1 vial for subcutaneous (SC) administration is being developed as a ready-to-use formulation to reduce the treatment burden on patients while improving healthcare efficiency. An open-label, 2-part, phase Ib dose-finding study (NCT02738970) was undertaken in healthy male volunteers (part 1) and female patients with HER2-postive early breast cancer who had completed standard (neo)adjuvant treatment (part 2). This study aimed to identify an SC pertuzumab dose given with recombinant human hyaluronidase that results in comparable exposure to that of the intravenous (IV) pertuzumab dose, based on pertuzumab serum trough concentration and area under the serum concentration-time curve. Pharmacokinetics (PK), safety, and tolerability of a single dose of SC pertuzumab given alone or in a fixed-dose combination (comixed or coformulated) with trastuzumab were also assessed. A maintenance dose of 600 mg for SC pertuzumab resulted in an equivalent exposure to that of IV pertuzumab, and no new safety signals were identified for SC pertuzumab or trastuzumab. A loading dose of 1200 mg for SC pertuzumab was selected based on approximate dose proportionality. The PK and safety results support further development of a fixed-dose coformulation combination of pertuzumab and trastuzumab for SC administration, which will be investigated in an upcoming phase III trial in patients with HER2-positive early breast cancer.
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Affiliation(s)
| | - Chris Wynne
- Christchurch Clinical Studies Trust, Christchurch, New Zealand
| | | | | | | | - Bei Wang
- Genentech, Inc., South San Francisco, CA, USA
| | - Ihsan Nijem
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | | | - Amit Garg
- Genentech, Inc., South San Francisco, CA, USA
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18
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Phase I trial of afatinib and 3-weekly trastuzumab with optimal anti-diarrheal management in patients with HER2-positive metastatic cancer. Cancer Chemother Pharmacol 2018; 82:979-986. [PMID: 30350178 PMCID: PMC6267664 DOI: 10.1007/s00280-018-3689-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/17/2018] [Indexed: 12/30/2022]
Abstract
Background Trastuzumab is the mainstay of therapy for patients with HER2-positive breast and gastric cancer but resistance frequently occurs. Afatinib, an irreversible oral ErbB family blocker, shows clinical activity in trastuzumab-refractory HER2-positive metastatic breast cancer. Materials and methods This phase I study used a modified 3 + 3 dose escalation design to determine the maximum tolerated dose (MTD) of oral once-daily afatinib in combination with 3-weekly intravenous trastuzumab (8 mg/kg week 1; 6 mg/kg 3-weekly thereafter) for patients with confirmed advanced or metastatic HER2-positive cancer. Results Of the 13 patients treated, 6 received daily afatinib 20 mg and 7 received 30 mg. One patient who received afatinib 30 mg developed a tumor lysis syndrome and was not evaluable for dose-limiting toxicity (DLT). Two of the six remaining patients receiving afatinib 30 mg and 1 of the 6 patients receiving afatinib 20 mg experienced DLTs (all CTCAE ≥ grade 2 diarrhea despite optimal management) in the first treatment cycle. The most common drug-related adverse events were diarrhea (n = 13, 100%), asthenia (n = 8, 61.5%), rash (n = 7, 53.8%) and paronychia (n = 5, 38.5%). No pharmacokinetic interaction was observed. One patient (7.7%) had an objective response (20 mg afatinib cohort). Nine patients (69.2%) experienced clinical benefit. Conclusions Despite optimal management of diarrhea including treatment of grade I symptoms, it was not possible to treat the patients above a dose of 20 mg of afatinib daily in combination with 3-weekly trastuzumab. The MTD of afatinib in combination with the recommended 3-weekly dose of trastuzumab was 20 mg daily.
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19
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Fasching PA, Hartkopf AD, Gass P, Häberle L, Akpolat-Basci L, Hein A, Volz B, Taran FA, Nabieva N, Pott B, Overkamp F, Einarson H, Hadji P, Tesch H, Ettl J, Lüftner D, Wallwiener M, Müller V, Janni W, Fehm TN, Schneeweiss A, Untch M, Pott D, Lux MP, Geyer T, Liedtke C, Seeger H, Wetzig S, Hartmann A, Schulz-Wendtland R, Belleville E, Wallwiener D, Beckmann MW, Brucker SY, Kolberg HC. Efficacy of neoadjuvant pertuzumab in addition to chemotherapy and trastuzumab in routine clinical treatment of patients with primary breast cancer: a multicentric analysis. Breast Cancer Res Treat 2018; 173:319-328. [PMID: 30324275 DOI: 10.1007/s10549-018-5008-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE Neoadjuvant combination treatment with chemotherapy (CTX), trastuzumab (TZM), and pertuzumab (PTZ) has been shown to result in higher pathological complete response rates (pCR) in comparison with treatment with chemotherapy and trastuzumab (CTX/TZM). This analysis was aimed at real-world validation of these results from prospective randomized trials. METHODS In a retrospective analysis conducted in the PRAEGNANT network, patients were eligible for inclusion if they had either received neoadjuvant therapy with CTX/TZM or chemotherapy, trastuzumab, and pertuzumab (CTX/TZM/PTZ) and subsequently underwent surgery for their primary breast cancer. The effect of the two neoadjuvant regimens on pCR in addition to commonly applicable predictors of pCR was analyzed in 300 patients from three study sites, using logistic regression analyses with treatment arm, age, clinical tumor stage, grading, and hormone receptor status as predictors. RESULTS pCR with complete disappearance of all tumor cells was seen in 30.2% (n = 58) of patients treated with CTX/TZM and in 52.8% (n = 57) of those treated with CTX/TZM/PTZ. CTX/TZM/PTZ was positively associated with pCR (adjusted odds ratio 2.44; 95% CI 1.49-4.02). Mastectomy rates were not influenced by the therapy. CONCLUSIONS The results of clinical trials were confirmed in this dataset of patients who were treated outside of clinical trials in everyday routine work. pCR rates can be improved by 20% with pertuzumab in routine clinical use.
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Affiliation(s)
- Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | | | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Bernhard Volz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Naiba Nabieva
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | | | | | - Hanna Einarson
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Peyman Hadji
- Frankfurter Hormon und Osteoporosezentrum Goethestrasse, Goethestr.23, Frankfurt, Germany
| | - Hans Tesch
- Oncology Practice, Bethanien Hospital, Frankfurt am Main, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases and Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin-Buch, Berlin, Germany
| | - Dirk Pott
- Onkologische Schwerpunktpraxis Bottrop, Bottrop, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Thomas Geyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Cornelia Liedtke
- Department of Gynecology and Breast Center, Charité University Hospital, Campus Mitte, Berlin, Germany
| | - Harald Seeger
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Institute of Diagnostic Radiology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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20
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Schneeweiss A, Park-Simon TW, Albanell J, Lassen U, Cortés J, Dieras V, May M, Schindler C, Marmé F, Cejalvo JM, Martinez-Garcia M, Gonzalez I, Lopez-Martin J, Welt A, Levy C, Joly F, Michielin F, Jacob W, Adessi C, Moisan A, Meneses-Lorente G, Racek T, James I, Ceppi M, Hasmann M, Weisser M, Cervantes A. Phase Ib study evaluating safety and clinical activity of the anti-HER3 antibody lumretuzumab combined with the anti-HER2 antibody pertuzumab and paclitaxel in HER3-positive, HER2-low metastatic breast cancer. Invest New Drugs 2018; 36:848-859. [PMID: 29349598 PMCID: PMC6153514 DOI: 10.1007/s10637-018-0562-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/10/2018] [Indexed: 01/03/2023]
Abstract
Purpose To investigate the safety and clinical activity of comprehensive human epidermal growth factor receptor (HER) family receptor inhibition using lumretuzumab (anti-HER3) and pertuzumab (anti-HER2) in combination with paclitaxel in patients with metastatic breast cancer (MBC). Methods This phase Ib study enrolled 35 MBC patients (first line or higher) with HER3-positive and HER2-low (immunohistochemistry 1+ to 2+ and in-situ hybridization negative) tumors. Patients received lumretuzumab (1000 mg in Cohort 1; 500 mg in Cohorts 2 and 3) plus pertuzumab (840 mg loading dose [LD] followed by 420 mg in Cohorts 1 and 2; 420 mg without LD in Cohort 3) every 3 weeks, plus paclitaxel (80 mg/m2 weekly in all cohorts). Patients in Cohort 3 received prophylactic loperamide treatment. Results Diarrhea grade 3 was a dose-limiting toxicity of Cohort 1 defining the maximum tolerated dose of lumretuzumab when given in combination with pertuzumab and paclitaxel at 500 mg every three weeks. Grade 3 diarrhea decreased from 50% (Cohort 2) to 30.8% (Cohort 3) with prophylactic loperamide administration and omission of the pertuzumab LD, nonetheless, all patients still experienced diarrhea. In first-line MBC patients, the objective response rate in Cohorts 2 and 3 was 55% and 38.5%, respectively. No relationship between HER2 and HER3 expression or somatic mutations and clinical response was observed. Conclusions Combination treatment with lumretuzumab, pertuzumab and paclitaxel was associated with a high incidence of diarrhea. Despite the efforts to alter dosing, the therapeutic window remained too narrow to warrant further clinical development. TRIAL REGISTRATION on ClinicalTrials.gov with the identifier NCT01918254 first registered on 3rd July 2013.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Diarrhea/chemically induced
- Female
- Humans
- Hypokalemia/chemically induced
- Middle Aged
- Paclitaxel/administration & dosage
- Paclitaxel/adverse effects
- Polymorphism, Single Nucleotide
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Receptor, ErbB-3/antagonists & inhibitors
- Receptor, ErbB-3/genetics
- Receptor, ErbB-3/metabolism
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Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Tjoung-Won Park-Simon
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology and Clinical Research Center, Hannover Medical School, Hannover, Germany
| | - Joan Albanell
- Department of Medical Oncology, Hospital del Mar, CIBERONC, Barcelona, Spain
| | | | - Javier Cortés
- Ramon y Cajal University Hospital, Madrid, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Marcus May
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology and Clinical Research Center, Hannover Medical School, Hannover, Germany
| | - Christoph Schindler
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology and Clinical Research Center, Hannover Medical School, Hannover, Germany
| | - Frederik Marmé
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Juan Miguel Cejalvo
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia and CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | | | - Iria Gonzalez
- Department of Medical Oncology, Hospital del Mar, CIBERONC, Barcelona, Spain
| | - Jose Lopez-Martin
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Anja Welt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Christelle Levy
- Departments of Clinical Research Unit and Medical Oncology, Centre François Baclesse, Caen, France
| | - Florence Joly
- Departments of Clinical Research Unit and Medical Oncology, Centre François Baclesse, Caen, France
| | - Francesca Michielin
- Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | - Wolfgang Jacob
- Pharma Research and Early Development (pRED), Roche Innovation Center Munich, Penzberg, Germany.
| | - Céline Adessi
- Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | - Annie Moisan
- Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | - Georgina Meneses-Lorente
- Pharma Research and Early Development (pRED), Roche Innovation Center Welwyn, Welwyn Garden City, UK
| | - Tomas Racek
- Pharma Research and Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | | | - Maurizio Ceppi
- Pharma Research and Early Development (pRED), Roche Innovation Center Munich, Penzberg, Germany
| | - Max Hasmann
- Pharma Research and Early Development (pRED), Roche Innovation Center Munich, Penzberg, Germany
| | - Martin Weisser
- Pharma Research and Early Development (pRED), Roche Innovation Center Munich, Penzberg, Germany
| | - Andrés Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia and CIBERONC, Institute of Health Carlos III, Madrid, Spain
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21
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Murthy RK, Chavez-MacGregor M, Hortobagyi GN. Adjuvant HER2-Targeted Therapy Update in Breast Cancer: Escalation and De-escalation of Therapy in 2018. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0290-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Moisan A, Michielin F, Jacob W, Kronenberg S, Wilson S, Avignon B, Gérard R, Benmansour F, McIntyre C, Meneses-Lorente G, Hasmann M, Schneeweiss A, Weisser M, Adessi C. Mechanistic Investigations of Diarrhea Toxicity Induced by Anti-HER2/3 Combination Therapy. Mol Cancer Ther 2018; 17:1464-1474. [DOI: 10.1158/1535-7163.mct-17-1268] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/23/2018] [Accepted: 04/06/2018] [Indexed: 11/16/2022]
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23
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Corrigendum: mdw197, mdw434 and mdw695. Ann Oncol 2018; 29:1075. [DOI: 10.1093/annonc/mdx336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Yu S, Liu Q, Han X, Qin S, Zhao W, Li A, Wu K. Development and clinical application of anti-HER2 monoclonal and bispecific antibodies for cancer treatment. Exp Hematol Oncol 2017; 6:31. [PMID: 29209558 PMCID: PMC5704598 DOI: 10.1186/s40164-017-0091-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022] Open
Abstract
HER2-targeted immunotherapy consists of monoclonal antibodies (e.g. trastuzumab, pertuzumab), bispecific antibodies (e.g. MM-111, ertumaxomab) and activated T cells armed with anti-HER2 bispecific antibody (HER2Bi-aATC). Trastuzumab is a classic drug for the treatment of HER2 positive metastatic breast cancer. The combined application of pertuzumab, trastuzumab and paclitaxel has been suggested as a standard therapy for HER2 positive advanced breast cancer. The resistance to anti-HER2 antibody has resulted in disease progression. HER2-directed bispecific antibody may be a promising therapeutic approach for these patients. Ertumaxomab enhanced the interaction of immune effector cells and tumor cells. MM-111 simultaneously binds to HER2 and HER3 and blocks downstream signaling. Besides, HER2Bi-aATC is also an alternative therapeutic approach for HER2 positive cancers. In this review, we summarized the recent advancement of HER2-targeted monoclonal antibodies (trastuzumab, pertuzumab and T-DM1) and bispecific antibodies (MM-111, ertumaxomab and HER2Bi-aATC), especially focus on clinical trial results.
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Affiliation(s)
- Shengnan Yu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 China
| | - Qian Liu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Shuang Qin
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 China
| | - Weiheng Zhao
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 China
| | - Anping Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030 China
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25
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Soyano AE, Reynolds G, Moreno-Aspitia A, Chumsri S. Rifaximin for Pertuzumab-Related GI Toxicities. Front Oncol 2017; 7:168. [PMID: 28848707 PMCID: PMC5550690 DOI: 10.3389/fonc.2017.00168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 07/25/2017] [Indexed: 01/03/2023] Open
Abstract
Pertuzumab is a monoclonal antibody against HER2. Diarrhea and abdominal pain are common adverse events of pertuzumab-based therapy, occurring in almost 70% of patients. The incidence of gastrointestinal toxicities intensifies when pertuzumab is given in combination with chemotherapy. Rifaximin, a non-absorbable oral antibiotic, may provide symptomatic relief in patients with refractory gastrointestinal toxicities from pertuzumab-based therapy beyond standard routine antidiarrheal medications. We present a case of HER2-related therapy-induced diarrhea and abdominal pain managed successfully with Rifaximin.
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Affiliation(s)
- Aixa E Soyano
- Robert and Monica Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, United States
| | - Gina Reynolds
- Robert and Monica Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, United States
| | - Alvaro Moreno-Aspitia
- Robert and Monica Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, United States
| | - Saranya Chumsri
- Robert and Monica Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL, United States
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