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Pertuzumab: of variable benefit depending on the type of breast cancer

In some patients with metastatic breast cancer, pertuzumab in combination with trastuzumab + docetaxel is proven to extend life, but at the cost of increased cardiac adverse effects. There is no evidence that this drug is beneficial as a neoadjuvant treatment when the breast cancer has not metastasised.

In women with non-metastasised invasive breast cancer, surgery is the reference treatment. When cytotoxic chemotherapy is considered in addition to surgery, chemotherapy is begun either before or after surgery.

Pertuzumab has been authorised for use in combination with trastuzumab + docetaxel in the treatment of patients with metastatic HER2-positive breast cancer who have not received chemotherapy or trastuzumab at this stage of the disease. The data from a clinical trial confirm the efficacy of this combination on life extension (12% more women still alive after 4 years), but with a cardiac risk that requires monitoring.

Pertuzumab has also been authorised as a neoadjuvant, i.e. commenced before surgery in addition to trastuzumab and chemotherapy, in women with non-metastasised HER2-positive breast cancer. The only relevant trial did not conclude that the addition of pertuzumab reduces the extent of surgery. In this trial, mortality appeared to be higher in patients who received this combination (7.5% versus 5.6%).

As of late 2016, it is not considered justifiable to add pertuzumab to a pre-surgery  treatment.

©Prescrire 1 July 2017

"Pertuzumab (Perjeta°) before breast cancer surgery. Co-administered with trastuzumab: no benefit but more adverse effects" Prescrire Int 2017; 26 (184): 176-177. (Pdf, subscribers only).

"Pertuzumab (Perjeta°) and metastatic breast cancer. Longer survival confirmed, but cardiac risks to be monitored " Prescrire Int 2017; 26 (184): 178-179. (Pdf, subscribers only).

Download the full reviews:

Pertuzumab before
breast cancer surgery.
Pdf, subscribers only

Pertuzumab and metastatic
breast cancer
Pdf, subscribers only