Before the appearance of treatment directed against HER2, the cancer of the mother HER2 is positively characterized by being the subtype of cancer of the mother with a prognostic factor.
The double block of the HER2 receptor with pertuzumab (Perjeta) and trastuzumab (Herceptin) together with chemotherapy, has a very relevant clinical advance in patients with breast cancer, although considerably the clearest benefit is provided by Herceptin. This combination was approved for the first time in the treatment of the metastatic stage of breast cancer HER2 positive, thanks to the results observed in the CLEOPATRA study.
The metastatic stage of breast cancer is, high by high, ongeneeslik, being the goal of treatment prolongs survival and increases the quality of life of patients.
Without embarrassment, he passed away this month, more than 8 years later (final analysis of the CLEOPATRA study1, published in 2020 in ‘Lancet Oncology’) is continuously observing a very relevant clinical benefit with the anti-HER2 double block in metastatic breast cancer. And it is with the combination of trastuzumab (Herceptin) and pertuzumab (Perjeta) that an increase in global surveillance is observed in these patients that is statistically significant and clinically relevant of 16.3 months, spanning a median of 57.1 months. Additionally, metastatic and overweight treatment is difficult, over 8 years of follow-up, 37% of patients treated with this combination live continuously, and 16% have not progressed to the first line.
Cleopatra Study1. Supervivencia Global – final analysis of the studio
Ana Lluch is the Coordinator of the area of breast cancer research at the Clinical Hospital of the University of Valencia. The oncologist approaches the good results that are obtained from the patient to the combination of trastuzumab and pertuzumab.
PRIVILEGES. How do you determine if a patient has a positive HER2 cancer?
RESPUESTA. The manner in which maternal cancer is determined has evolved over the last few years and is currently differentiated into subgroups of patients, depending on its biological (immunohistochemical) determination or genomic platform (mammaprint). Thus, we determine that a patient has cancer of the lumbar spine when the growth of his cells depends on the hormones. We call HER2 breast cancer when the cells of this tumor are expressed in the surface of one of the HER2 receptor receptors. These patients are different in form from the other patient subgroups. In this way, it is today that we have the most important biology in the cells of cancer that have other characteristics of the same that are classically more important.
P. Is there any predisposition to have this type of cancer?
R. There is no predisposition, nor can we predict which patient will have a HER2 positive or not. The same thing happens if the patient has triple negative, and the women with breast cancer heredity suelen are predictably triple negative.
Ana Lluch is Coordinator of the Area of Breast Cancer Surgery at the Clinical Hospital of the University of Valencia
P. Is it necessary to say that the anti-HER2 therapy has changed the natural history of metastatic disease? What is the use of Herceptin and Perjeta for the evolution of this disease?
R. The determination of this type of breast cancer has changed the history of the metastatic disease of these patients. Antes, only podiums offer a treatment with chemotherapy. Since we took anti-HER2 treatment (10 years ago), this natural history of patients with breast cancer and this tumor subtype has changed radically. These sobreviven patients spend most of their time and our results are never seen in nurses with metastatic breast cancer. With the treatment of the double combination, trastuzumab (Herceptin) and pertuzumab (Perjeta), together with chemotherapy (docetaxel), it has been approved to shorten a media of 5 years. Given the type of metastasis that tengan (higado, pulmon, hueso). No HER2-positive metastatic patient currently has anything to do with this combination.
P. In the Cleopatra Study, over 8 years of follow-up, 37% of patients treated with Continuous Living and 16% have not progressed, showing that these patients are receiving a clinical benefit many years later. What are the implications of these results for patients and what is the significance of the fact that over the past 8 years there has been a high survival rate?
R. The Cleopatra studio has demonstrated that the combination of these monoclonal anticoagulants together with chemotherapy increases the life of patients. It’s cancer of a metastatic mother is not easy to convince because the Pharmacy Mayor suelen increase the time the patient is without progress, to increase global surveillance, it is necessary to increase the total number of years that the patient lives, more difficult and with the combination is followed. Given the implications for patients, there are many. Although we think that one year or two does not matter, for them it has much value, because all because of its pharmacies that have secondary effects and are very tolerant. Tampoco suffers from alopecia of chemotherapy and treatment does not produce nausea or vomit. Most importantly, its control is toxic toxic cardiac. It is a treatment that can generally be performed for a long time with no secondary effects.
P. Respect for the security profile, especially the cardiac, What conclusions do the results of the final analysis of the Cleopatra study make?
R. Cardiac toxicity is not an important problem because it is not permanent, it is reversible. If we detect that the patient has this toxicity, he should administer it during the three months and, in this way, the patient recovers his cardiac function.
P. What is the purpose for you to have a therapeutic option in metastatic disease such as the combination of Perjeta and Herceptin?
R. Fue un antes y un después. Although we do not know how to dispose of this medication, even if a HER2 patient is positive with metastasis, we know that we are able to monitor and increase life. In addition to the benefits of these pharmacies in metastatic patients, it should be noted that they have very good results in women with breast cancer in metastatic patients. If we treat this before the surgery, there are 60-65% of patients who have had one month of surgery, the tumor is not in the mother or in the axilla, which is a complete pathological remission.
1. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA): final results of a double-blind, randomized, placebo-controlled phase 3 study. Swain SM, et al. Lancet Oncol 2020; 21: 519–530.
2. Perjeta Technology Sheet and Herceptin Technology Sheet