Toxicity After Chemo May be Avoided With Anastrozole Combo in Breast Cancer
It may be possible to use anastrozole plus palbociclib, trastuzumab, and pertuzumab in place of chemotherapy in the frontline setting for hormone receptor–positive, HER2-positive metastatic breast cancer, says Amy Tiersten, MD.
Amy Tiersten, MD, spoke with CancerNetwork® during the 2023 San Antonio Breast Cancer Symposium (SABCS) about how a regimen consisting of anastrozole (Arimidex), palbociclib (Ibrance), trastuzumab (Herceptin), and pertuzumab (Perjeta) may be a viable frontline treatment option outside of chemotherapy for those with hormone receptor (HR)–positive, HER2-positive metastatic breast cancer.
According to Tiersten, professor of medicine and clinical director of Breast Medical Oncology at Mount Sinai Hospital, said that the aforementioned combination produced a high clinical benefit rate and enduring responses based on data from the phase 1/2 ASPIRE trial (NCT03304080). Additionally, she said that treating patients with this regimen may help this patient population avoid common adverse effects (AEs) associated with frontline chemotherapy, including neutropenia, nausea, and hair loss.
In the ASPIRE trial, the most frequent any-grade AEs following treatment with the experimental regimen included diarrhea (83%), neutropenia (87%), leukopenia (77%), and anemia (70%). Moreover, grade 3/4 toxicities included neutropenia (46%), leukopenia (23%), and anemia (17%).
Transcript:
It’s hugely important if we can have that kind of clinical benefit rate and duration of response, and have patients avoid the toxicities of chemotherapy such as hair loss, neutropenia, fever, and nausea; all the known [adverse] effects that come with chemotherapy. It’s a wonderful thing. Quality of life is always important, but it’s especially important in a group of patients in whom we’re not treating with curative intent and have many lines of therapy ahead of them. If we can delay more toxic therapy by as much as we can, that would only be a win for the patients.
I hope my colleagues take away that it may be possible to use this regimen in the frontline setting. Further studies are definitely necessary, but I hope people consider the possibility of a non-chemotherapy frontline setting in this group of patients.
Reference
Patel R, Cascetta K, Klein P, et al. A multicenter, phase I/II trial of anastrozole, palbociclib, trastuzumab, and pertuzumab in hormone receptor (HR)-positive, HER2-positive metastatic breast cancer (ASPIRE). Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX; abstract RF02-01.
