Dr. Crew on the APHINITY Trial Results in HER2+ Breast Cancer

Katherine D. Crew, MD, MS, director of Clinical Breast Cancer Prevention Program, Columbia University Irving Medical Center, and director of DataBase Shared Resource at Herbert Irving Comprehensive Cancer Center, Columbia University, discusses the results of the APHINITY trial in HER2-positive breast cancer.

The APHINITY trial examined pertuzumab (Perjeta) added to trastuzumab (Herceptin) and standard chemotherapy in patients with operable HER2-positive breast cancer who were either node-positive or high-risk node-negative, explains Crew. The addition of trastuzumab in the adjuvant setting improves invasive disease-free survival (iDFS) for patients with HER2-positive disease, and the APHINITY trial demonstrated a modest iDFS improvement with dual-HER2 blockade, says Crew.

The second interim analysis of the APHINITY trial, which was presented during the 2019 San Antonio Breast Cancer Symposium, showed continued improvement in iDFS with the adjuvant combination of trastuzumab and pertuzumab (Perjeta); however, most of the benefit occurred in patients with node-positive disease. Therefore, the addition of pertuzumab to trastuzumab is standard for patients with node-positive, HER2-positive breast cancer, according to Crew.

Many patients who have stage II disease should be receiving trastuzumab or pertuzumab in the neoadjuvant setting, says Crew. There are certain advantages to downstaging and assessing tumor sensitivity based on whether the patient develops a pathologic complete response, concludes Crew.