ESMO Breast 2019: De-escalation Strategy for Women With HER2-Positive Metastatic Breast Cancer
Posted: Monday, May 6, 2019
Researchers who conducted the PERNETTA trial found that a de-escalation strategy of omitting chemotherapy for women with HER2-positive metastatic breast cancer resulted in a similar 2-year overall survival and quality of life, although progression-free survival was significantly shorter. These study findings were presented at the 2019 European Society for Medical Oncology (ESMO) Breast Cancer Annual Congress (Abstract 150O_PR) in Berlin.
“We looked at 2-year overall survival because physicians are afraid they will lose patients early if they don’t give the maximum treatment,” stated Jens Huober, MD, of the University Hospital Ulm, Germany, in an ESMO press release. “Omitting chemotherapy in the first line could be discussed as an option with patients who have a low to intermediate tumor burden.”
The phase II trial randomly assigned 210 patients to trastuzumab plus pertuzumab alone (n = 105) versus trastuzumab plus pertuzumab combined with chemotherapy (n = 105) until disease progression. After disease progression, both groups received trastuzumab emtansine (T-DM1) as second-line therapy.
The 2-year overall survival rate was the same for both treatment arms (76.2%); results were similar regardless of hormone receptor status. Progression-free survival after first-line therapy was 8.4 months with antibodies alone and 23.3 months with the antibodies plus chemotherapy. Furthermore, quality of life was similar between both groups, although those receiving antibodies alone had less hair loss, mouth sores, nausea, and fatigue.
“Avoiding chemotherapy in HER2-positive disease is appealing for patients and investigators, but it has to be done safely,” stated ESMO spokesperson, Carmen Criscitiello, MD, PhD, of the European Institute of Oncology in Milan, Italy. Dr. Huober agrees that more research is necessary: “A phase III trial is needed for definitive proof that patients are not at risk of early death if they start with antibodies alone,” he proposed.
Disclosure: The study authors’ disclosure information may be found at cslide.ctimeetingtech.com.
