What is the number of cycles of Phesgo (pertuzumab, trastuzumab, and hyaluronidase) and Docetaxel given in the neoadjuvant stage?

From the Guidelines

In neoadjuvant treatment for HER2-positive breast cancer, Phesgo (fixed-dose combination of pertuzumab and trastuzumab) with docetaxel is typically given for 4 cycles. The standard regimen consists of Phesgo administered with docetaxel every 3 weeks for 4 cycles (12 weeks total), after which docetaxel is discontinued while Phesgo is continued for 4 more cycles with different chemotherapy agents like EC (epirubicin and cyclophosphamide) or AC (doxorubicin and cyclophosphamide) 1. This approach allows for a total of 8 cycles of Phesgo, with the first 4 cycles including docetaxel. The sequential approach helps maximize tumor response while managing toxicity. Phesgo combines the HER2-targeted therapies pertuzumab and trastuzumab, which work synergistically to block HER2 signaling pathways critical for tumor growth, while docetaxel provides cytotoxic effects by disrupting microtubule function in rapidly dividing cancer cells. Some studies have shown that the combination of pertuzumab and trastuzumab with chemotherapy significantly improves pathological complete response (pCR) rates compared to single anti-HER2 therapy plus chemotherapy 1. However, the most recent guidelines recommend a total of 4 cycles of Phesgo with docetaxel in the neoadjuvant setting, followed by additional cycles of Phesgo with other chemotherapy agents 1. Key points to consider when administering Phesgo with docetaxel include:

• The importance of completing the full 4 cycles of docetaxel to maximize tumor response
• The need to monitor patients closely for toxicity and adjust the treatment plan as needed
• The potential benefits of continuing Phesgo for an additional 4 cycles with other chemotherapy agents to further improve outcomes. Overall, the use of Phesgo with docetaxel in the neoadjuvant setting has been shown to be effective in improving pCR rates and reducing the risk of recurrence in patients with HER2-positive breast cancer 1.

From the FDA Drug Label

Neoadjuvant: Administer PERJETA, trastuzumab or trastuzumab hyaluronidase-oysk, and chemotherapy preoperatively every 3 weeks for 3 to 6 cycles. (2.2) The number of cycles of Phesgo (which includes pertuzumab and trastuzumab) and docetaxel given in the neoadjuvant stage is 3 to 6 cycles 2.

From the Research

Neoadjuvant Treatment for HER2-Positive Breast Cancer

• The standard of care in the neoadjuvant setting for HER2-positive breast cancer combines a taxane-containing chemotherapy with a dual blockade of trastuzumab and pertuzumab 3.
• Neoadjuvant therapy has become a standard clinical practice to downsize the tumor and increase the breast-conserving rate 4.
• The addition of trastuzumab to neoadjuvant chemotherapy roughly doubles the proportion of patients with HER2-positive breast cancer who achieve pathological complete response (pCR) 4.

Cycles of Phesgo and Docetaxel

• A fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection plus chemotherapy is used in the neoadjuvant setting for HER2-positive early breast cancer 5.
• Four cycles of HER2-targeted therapy are administered concurrently with the taxane, and after surgery, patients continue the HER2-targeted therapy to receive an additional 14 cycles (total of 18) 5.
• However, the exact number of cycles of Phesgo (a combination of pertuzumab and trastuzumab) and docetaxel is not explicitly stated in the provided studies.

Treatment Strategies

• Neoadjuvant treatment strategies for HER2-positive breast cancer include intensive regimens such as TCHP, THP + AC, and THP, as well as de-escalated regimens like TH and TDM-1 6.
• The choice of treatment strategy depends on various factors, including hormone receptor status, clinical stage, and chemotherapy regimen 6.