Editor's Note: When it comes to the "P" in the THP regimen for HER2-positive breast cancer, do you prefer Pertuzumab or Pyrotinib? At the 2024 Breast Cancer Summer Forum · Northern Salon's "Root Cause" session, Dr. Zhanhong Chen from Zhejiang Cancer Hospital and Dr. Rui Ge from Huadong Hospital Affiliated to Fudan University shared their perspectives. Professor Chen advocated for Pyrotinib, while Professor Ge favored Pertuzumab. After the session, Oncology Frontier invited both experts to elaborate on their viewpoints. 

Dr. Zhanhong Chen: Choosing Pyrotinib

From a mechanistic perspective, the combination of small and large molecules can produce a synergistic effect, potentially reversing Trastuzumab resistance. Pyrotinib, an indigenous small molecule TKI, is more suitable for China’s clinical landscape. Currently, over 80% of breast cancer patients receive dual-target therapy with Trastuzumab and Pertuzumab in neoadjuvant and adjuvant settings. For those who experience recurrence and progression, I recommend switching to a TKI with a different mechanism.

Additionally, the latest results from the PHILA study indicate that the median PFS for the Pyrotinib plus Trastuzumab and chemotherapy group (PyHT regimen) is 24.3 months, surpassing the 18.7 months reported in the CLEOPATRA study. This longer median PFS suggests a potential for better OS outcomes. Furthermore, this combination is endorsed by major guidelines and consensus statements both domestically and internationally. From a pharmacoeconomic standpoint, Pyrotinib’s inclusion in the national insurance formulary makes it more accessible, further justifying my preference for its use.

Dr. Rui Ge: Choosing Pertuzumab

When selecting a partner for Trastuzumab (H), the choice should be based on efficacy and suitability for advanced scenarios where H is indicated. Therefore, we consider several factors for the partner: 1) efficacy data; 2) survival data; and 3) treatment compliance, including adverse effect management.

Both the CLEOPATRA study and China’s bridging study, the Puffin study, show favorable PFS and OS data for patients treated with THP. Meanwhile, the PHILA study’s dual-target regimen currently lacks OS data. Moreover, clinical studies indicate that the discontinuation rate for the HP dual-target treatment is very low, virtually negligible.

Patients face numerous challenges during treatment, such as insurance coverage and adverse effect management. The Northern Salon provides an academic platform for debate not to find a right or wrong answer but to identify suitable patients for each regimen. This approach aims to provide more precise treatment, ensuring that patients derive greater benefits.

Vote

When considering the “P” in the THP regimen for HER2-positive breast cancer, do you prefer Pertuzumab or Pyrotinib? (Single choice)

• Pyrotinib
• Pertuzumab
• Abstain

Dr. Zhanhong Chen

• Chief Physician and Master’s Supervisor
• Deputy Director of the Breast Medicine Department and Head of the Breast Ward at Zhejiang Cancer Hospital
• Expert in the Breast Cancer Group of the National Anti-Cancer Drug Clinical Application Monitoring Expert Committee
• Standing Member of the Breast Professional Committee of the China Anti-Cancer Association
• Standing Member of the Breast Disease Expert Committee of the China Health Promotion Foundation
• Committee Member of the Breast Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO)/Editor of the CSCO BC Guidelines
• Committee Member of the Breast Cancer Group of the Tumor Physician Branch of the Chinese Medical Doctor Association
• Current Chairman of the Breast Tumor Diagnosis and Treatment Professional Committee of the Zhejiang Mathematical Medical Association
• Chairman-Elect of the Breast Clinical Trials Professional Committee of the Zhejiang Mathematical Medical Association
• Deputy Director of the Tumor Immunology and Biological Therapy Professional Committee of the Zhejiang Immunological Society
• Committee Member of the Breast Cancer Professional Committee of the Zhejiang Anti-Cancer Association
• Committee Member of the Medical Oncology Professional Committee of the Zhejiang Anti-Cancer Association

Dr. Rui Ge

• Deputy Director of Breast Surgery at Fudan University Affiliated Huadong Hospital
• Vice Chairman of the CSCO Youth Expert Committee
• Member and Secretary-General of the Breast Cancer Project Group of the Oncology Committee of the National Health Commission Capacity Building and Continuing Education Center
• Standing Member of the Patient Education Committee and Breast Cancer Committee of the CSCO
• Member of the Breast Cancer Professional Committee of the China Anti-Cancer Association
• Standing Member of the Breast Disease Branch of the China Medical and Health International Exchange Promotion Association
• Deputy Leader of the Breast Cancer Diagnosis and Treatment Technology Promotion Group of the Chinese National Health Association
• Member of the Breast Professional Committee of the Chinese Research Hospital Association
• Deputy Director of the Breast Health Science Committee of the Shanghai Science Popularization Volunteer Association
• Standing Member of the Breast Cancer Committee and Cancer Rehabilitation and Palliative Care Committee of the Shanghai Anti-Cancer Association
• Member of the Breast Cancer Group of the Surgery Branch of the Shanghai Medical Association
• Class President of the First Session of the Medical Star Program of the Shanghai Medical Development Foundation
• Editorial Board Member of the Chinese Edition of CA, Oncology Editor of the Chinese Medical Tribune, Reviewer for Frontiers in Oncology, JNCC, and Young Editorial Board Member of the Chinese Journal of Oncology