Dr. Mitri on Neratinib and Pertuzumab in HER2-Amplified Breast Cancer

Zahi Mitri, MD, MS, assistant professor of medicine, Oregon Health and Science University, discusses the use of neratinib (Nerlynx) and pertuzumab (Perjeta) in patients with HER2-amplified breast cancer.

In light of a recent subgroup analysis, there is a lot of talk whether physicians should use pertuzumab for ER-negative, HER2-amplified breast cancer and neratinib for ER-positive, HER2-amplified breast cancer, says Mitri. At this point, the primary endpoint in both studies was positive. If physicians want to do subgroup analyses, it seems that most of the benefit of neratinib is in the ER-positive subgroup.

For pertuzumab, the benefit is similar in both, but more so in the ER-negative subgroup. At this point, Mitri says he is sticking to the primary endpoint of the study. If physicians think that someone deserves pertuzumab upfront, they should offer neratinib subsequently. However, if someone has really bad tolerance to one or the other, then physicians have to address that. Though the overall survival was the same in the APHINITY study of pertuzumab and the ExteNET study of neratinib, the ER-negative subgroup did not seem to benefit, says Mitri.