The Who, What, Where, When and Sometimes, Why.

Pertuzumab (Perjeta) for Treatment of Metastatic Breast Cancer

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: About 10-20 percent of newly diagnosed breast cancers are HER2-positive [1-2]. This means they have high amounts of a protein called HER2 on the surface of the cancer cells.

The drugs pertuzumab (Perjeta) and trastuzumab (Herceptin) target HER2-positive cancer cells.

Pertuzumab in combination with trastuzumab and chemotherapy (taxane chemotherapy is preferred) can slow the growth of HER2-positive metastatic breast cancer and increase survival better than trastuzumab and chemotherapy alone [3]. The chemotherapy drug doxorubicin (Adriamycin) and other anthracyclines should not be used in this drug combination.

Learn more about pertuzumab (including its side effects) and metastatic breast cancer treatment.

Study selection criteria: Randomized clinical trials with 100 or more participants with HER2-positive metastatic breast cancer.  

Study

Study Population
(number of participants)

Drug(s) Used

Overall Response Rate—Percent who Responded to Treatment
(95% CI)

Overall Survival 
at One Year

Phase III clinical trials

CLEOPATRA study [4-7]

808

Pertuzumab and trastuzumab with chemotherapy
(docetaxel) 

69%

94%
(92-97%)*

 

 

Trastuzumab with chemotherapy
(docetaxel)

80%

89%
(86-92%)*

PHEREXA study [8]

452

Pertuzumab and trastuzumab with chemotherapy
(capecitabine) 

41%
(33-48%)NS

90%†

 

 

Trastuzumab with chemotherapy
(capecitabine)

33%
(26-41%)NS

85%†

CI = Confidence interval

NS = The response rate in the pertuzumab plus trastuzumab and chemotherapy group was not statistically significant from the response rate in the trastuzumab and chemotherapy group.

* Estimated survival at one year. Estimated 4-year survival was 58% for the pertuzumab + trastuzumab + docetaxel group and 45% for the trastuzumab + docetaxel group. Estimated 8-year survival was 37% for the pertuzumab + trastuzumab + docetaxel group and 23% for the trastuzumab + docetaxel group.

† Estimated survival at 10 months.

References

  1. Rakha EA, Pinder SE, Bartlett JM, et al. for the National Coordinating Committee for Breast Pathology. Updated UK recommendations for HER2 assessment in breast cancer. J Clin Pathol. 68(2):93-9, 2015.
  2. Joe BN. Clinical features, diagnosis, and staging of newly diagnosed breast cancer. In: UpToDate. Burstein H, Vora SR (eds.). Waltham, MA: UpToDate, 2019.
  3. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: breast cancer. V.3.2020. http://www.nccn.org, 2020.
  4. Baselga J, Cortés J, Kim SB, et al. for the CLEOPATRA Study Group. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med. 366(2):109-19, 2012.
  5. Swain SM, Kim SB, Cortés J, et al on behalf of the CLEOPATRA Study Group. 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. 14(6):461-71, 2013.
  6. Swain SM, Baselga J, Kim SB, et al. for the CLEOPATRA Study Group. Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. N Engl J Med. 372(8):724-734, 2015.
  7. Swain SM, Miles D, Kim SB, et al. for the CLEOPATRA study group. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA): end-of-study results from a double-blind, randomised, placebo-controlled, phase 3 study. Lancet Oncol. 21(4):519-530, 2020.
  8. Urruticoechea A, Rizwanullah M, Im SA, et al. Randomized phase III trial of trastuzumab plus capecitabine with or without pertuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer who experienced disease progression during or after trastuzumab-based therapy. J Clin Oncol. 35(26):3030-3038, 2017. 

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