Future Perspective
Before the results of studies evaluating the activity and efficacy of the new anti-HER-2 targeted agents, pertuzumab and TDM-1, treatment cascade in HER-2-positive metastatic breast cancer included treatment with trastuzumab and taxanes, or the alternative association of trastuzumab and vinorelbine and TDM-1, treatment cascade in HER-2-positive metastatic breast cancer included treatment with trastuzumab and taxanes, or the alternative association of trastuzumab and vinorelbine in first-line therapy, lapatinib and capecitabine in second-line therapy, and trastuzumab associated with other chemotherapeutic agents in third line therapy and beyond.
The results of pivotal Phase III studies with pertuzumab and TDM-1 are changing this therapeutic approach and will provide new treatment options for HER-2-positive metastatic breast cancer patients.
In the near future, pertuzumab associated with trastuzumab and taxanes will become the new standard first-line treatment for HER-2-positive metastatic breast cancer patients, according to the results of Baselga et al.
TDM-1 will be the new treatment for HER-2-positive metastatic breast cancer patients who progressed after a first-line treatment with trastuzumab, in agreement with the results of the EMILIA study.
Lapatinib associated with capecitabine will remain the therapeutic option in third-line treatment of HER-2-positive metastatic breast cancer patients.
Ongoing studies are evaluating the role of TDM-1 in neoadjuvant, adjuvant and metastatic settings. In advanced disease, TDM-1 is under investigation as a monotherapy or in combination with other drugs, chemotherapies and/or biological agents. The MARIANNE study is a three-arm ongoing Phase III study comparing TDM-1 with or without pertuzumab versus standard therapy (trastuzumab plus taxane) for the first-line treatment of HER-2-positive metastatic breast cancer patients. This study will clarify the potential of TDM-1 as a first-line treatment.