Deciding Management for Early HER2-Positive Breast Cancer

Patients Prefer Subcutaneous Regimen for HER2-Positive Breast Cancer

Andrew Seidman, MD, discusses the PHranceSCa trial of patient preference for intravenous versus subcutaneous trastuzumab and pertuzumab for neoadjuvant treatment of HER2-positive breast cancer.

Andrew Seidman, MD, medical director of the Bobst International Center at Memorial Sloan Kettering Cancer Center, discusses the PHranceSCa trial (NCT03674112) of patient preference for intravenous versus subcutaneous trastuzumab (Herceptin) and pertuzumab (Perjeta) for neoadjuvant treatment of HER2-positive breast cancer.

The phase 2 trial enrolled 160 patients who have completed neoadjuvant chemotherapy with pertuzumab and trastuzumab and have undergone surgical treatment for HER2-positive early breast cancer. The FeDeriCa trial (NCT03493854) found that subcutaneous trastuzumab and pertuzumab had similar efficacy compared with intravenous treatment.

Patients in the PHranceSCa trial were randomized to receive 3 cycles of 21 days of either intravenous or subcutaneous trastuzumab and pertuzumab, then receive the other formulation for the next 3 cycles. Following this cross-over period, patients were able to select 1 of the 2 treatments for up to 18 cycles in the continuation period.

According to Seidman, 85% of patients chose the subcutaneous formulation, known as Phesgo. The most common reasons given by patients were shorter infusion time and greater comfort than intravenous infusion.

TRANSCRIPTION

0:08 | It's one thing to show that we have another route of administration, subcutaneous compared to intravenous, to offer patients who are appropriate candidates for trastuzumab and pertuzumab. It’s another thing to fulfill an unmet need. So do patients really desire this route of administration?

So, here the PHranceSCa study involved 160 patients who had finished neoadjuvant chemotherapy, as well as intravenous trastuzumab and pertuzumab and these patients were preassigned to receive either adjuvant trastuzumab intravenously for 3 cycles, followed by pertuzumab for 3 cycles, or the inverse sequence. So they were given subcutaneous dosing with Phesgo for 3 cycles, and then switched to intravenous administration.

Then they were asked to choose how they would like to spend the remaining months that they had getting adjuvant HER2 antibodies. And that trial was very enlightening because 85% of patients preferred the subcutaneous route of administration to intravenous.