From the Guidelines
In the neoadjuvant stage for HER2-positive breast cancer, Phesgo (pertuzumab and trastuzumab) is administered with docetaxel, but the provided evidence does not specify the exact dosing of Phesgo with docetaxel. The treatment of HER2-positive early breast cancer involves neoadjuvant therapy with pertuzumab–trastuzumab and chemotherapy, such as docetaxel, for patients with high-risk disease 1.
- The standard approach includes deciding between neoadjuvant therapy or proceeding directly to surgery based on the risk of the disease.
- Neoadjuvant chemotherapy plus pertuzumab–trastuzumab is recommended for patients with high-risk HER2-positive EBC (tumour diameter ≥2 cm, and/or node-positive disease) 1.
- While the exact dosing of Phesgo with docetaxel in the neoadjuvant setting is not detailed in the provided evidence, the combination of a taxane (like docetaxel) with dual HER2 blockade (such as Phesgo) is a common approach in clinical practice.
- The goal of neoadjuvant therapy is to achieve a total pathological complete response (tpCR), which is associated with improved survival endpoints 1.
- Treatment recommendations should be consistent with local and international guidelines, considering the risk of disease recurrence and the patient's ability to tolerate the treatment regimen 1.
From the FDA Drug Label
In the FEC cohort, 5-Fluorouracil (5-FU) (500 mg/m2), epirubicin (100 mg/m2), and cyclophosphamide (600 mg/m2) were given intravenously every 3 weeks for 4 cycles, followed by docetaxel given as an initial dose of 75 mg/m2 by intravenous infusion every 3 weeks for 4 cycles with PERJETA and trastuzumab, and with the option to escalate to 100 mg/m2 at the investigator's discretion if the initial dose was well tolerated.
The dose of docetaxel given in the neoadjuvant stage is 75 mg/m2 by intravenous infusion every 3 weeks for 4 cycles, with the option to escalate to 100 mg/m2 at the investigator's discretion if the initial dose is well tolerated 2.
From the Research
Neoadjuvant Stage Treatment
- The dosage of docetaxel in the neoadjuvant stage for patients with HER2-positive breast cancer is 75 mg/m2 on day 1, as part of a regimen that includes carboplatin, trastuzumab, and pertuzumab 3, 4, 5, 6.
- This regimen is administered for six 3-week cycles, with docetaxel given on day 1 of each cycle 3, 4, 5, 6.
- The use of docetaxel in combination with carboplatin, trastuzumab, and pertuzumab has been shown to be effective in achieving pathological complete response (pCR) in patients with HER2-positive breast cancer, with pCR rates ranging from 53% to 64% 3, 5, 6.
- The safety and efficacy of this regimen have been evaluated in several studies, with manageable toxicity and no significant differences in terms of adverse events compared to other regimens 3, 4, 5, 6.
Comparison with Other Regimens
- A study comparing docetaxel plus carboplatin with nab-paclitaxel, both in combination with trastuzumab and pertuzumab, found that the nab-paclitaxel regimen had a higher pCR rate (66.3% vs 57.6%) and fewer adverse events 3.
- Another study found that the addition of carboplatin to docetaxel and trastuzumab did not enhance antitumor activity, but did increase toxicity 4.
- A phase 2 study of nab-paclitaxel, trastuzumab, and pertuzumab found a pCR rate of 64% and manageable toxicity, suggesting that this regimen may be a viable alternative to docetaxel-based regimens 7.