Dr. Rahman on Pertuzumab and Neratinib in HER2+ Breast Cancer

Mohammed J. Rahman, MD, oncologist, University of Pittsburgh Medical Center, discusses the use of pertuzumab (Perjeta) and neratinib (Nerlynx) for the treatment of patients with HER2-positive breast cancer.

Trying to distinguish between these targeted agents is an open question, mainly because they have similar toxicity profiles, Rahman says. Both agents cause gastrointestinal adverse events such as diarrhea, therefore, it is sometimes difficult for patients to complete this treatment. Residual disease burden is an important factor to take into consideration.

If a patient has a large tumor at diagnosis and still has high-grade, node-positive disease after neoadjuvant treatment with trastuzumab (Herceptin) monotherapy or in combination, physicians can categorize these patients as high-risk. These patients will then need to be treated with a more aggressive treatment strategy; this is when neratinib would be introduced to the equation, Rahman says.

Neratinib should be started sooner rather than later in order to provide the most benefit to patients with HER2-positive or estrogen receptor—positive breast cancer, he adds. As more data become available, the relationship between pertuzumab and neratinib will become more clearly defined.