Vol 13, No 2 (2017)
Review paper
Published online: 2017-08-25

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Practical aspects of pertuzumab treatment in patients with breast cancer — management of the most common adverse events

Roman Dubiański1, Anna Górniak
DOI: 10.5603/OCP.2017.0010
Oncol Clin Pract 2017;13(2):61-66.

Abstract

Treatment outcomes of patients diagnosed with breast cancer with overexpression of the HER2 receptor have been significantly improved by the use of pertuzumab. Its use, however, is associated with the occurrence of various, more or less severe, adverse events. Some of them had already been observed in clinical practice during treatment with another monoclonal antibody directed against the HER2 receptor, trastuzumab. New toxicities, which occurred in a higher grade or significantly more frequently during treatment with pertuzumab are diarrhoea, neutropaenia and febrile neutropaenia, and skin toxicities. Their severity is generally acceptable, and proper management in the case of their occurrence is crucial for optimal causal treatment. This paper proposes schemes for management of the most common adverse events during the use of pertuzumab.

References

  1. Franklin MC, Carey KD, Vajdos FF, et al. Insights into ErbB signaling from the structure of the ErbB2-pertuzumab complex. Cancer Cell. 2004; 5(4): 317–328.
  2. Yarden Y, Pines G. The ERBB network: at last, cancer therapy meets systems biology. Nat Rev Cancer. 2012; 12(8): 553–563.
  3. Lee-Hoeflich SiT, Crocker L, Yao E, et al. A central role for HER3 in HER2-amplified breast cancer: implications for targeted therapy. Cancer Res. 2008; 68(14): 5878–5887.
  4. Baselga J, Cortés J, Kim SB, et al. CLEOPATRA Study Group. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med. 2012; 366(2): 109–119.
  5. Swain SM, Baselga J, Kim SB, et al. CLEOPATRA Study Group. CLEOPATRA: a phase III evaluation of pertuzumab and trastuzumab for HER2-positive metastatic breast cancer. Clin Breast Cancer. 2010; 10(6): 489–491.
  6. Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012; 13(1): 25–32.
  7. Schneeweiss A, Chia S, Hickish T, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013; 24(9): 2278–2284.
  8. https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
  9. Miles D, Lacasia A, Lee L, et al. Skin and subcutaneous tissue disorders (SSTDs) in patients (pts) with HER2-positive metastatic breast cancer (MBC) in the phase III trial CLEOPATRA of pertuzu- mab or placebo with trastuzumab and docetaxel. J Clin Oncol. 2015; 33(15): Suppl598.
  10. Mortimer JE, Jung JJ, Yuan Y, et al. Skin, nail, and staphylococcal infections associated with the addition of pertuzumab to trastuzu- mab-based chemotherapy. ASCO Meet Abstr . 2015; 33(15): e11610.
  11. Mortimer J, Jung J, Yuan Y, et al. Skin/nail infections with the addition of pertuzumab to trastuzumab-based chemotherapy. Breast Cancer Res Treat. 2014; 148(3): 563–570.
  12. Aapro MS, Bohlius J, Cameron DA, et al. European Organisation for Research and Treatment of Cancer. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer. 2011; 47(1): 8–32.
  13. Klastersky J, de Naurois J, Rolston K, et al. ESMO Guidelines Committee. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016; 27(suppl 5): v111–v118.
  14. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive.
  15. Van Sebille YZA, Gibson RJ, Wardill HR, et al. ErbB small molecule tyrosine kinase inhibitor (TKI) induced diarrhoea: Chloride secretion as a mechanistic hypothesis. Cancer Treat Rev. 2015; 41(7): 646–652.
  16. Melosky B. Supportive care treatments for toxicities of anti-egfr and other targeted agents. Curr Oncol. 2012; 19(Suppl 1): S59–S63.
  17. Swain SM, Schneeweiss A, Gianni L, et al. Incidence and management of diarrhea in patients with HER2-positive breast cancer treated with pertuzumab. Ann Oncol. 2017; 28(4): 761–768.
  18. Gao J, Swain SM. Pertuzumab for the treatment of breast cancer: a safety review. Expert Opin Drug Saf. 2016; 15(6): 853–863.