Anastrozole Combo Yields High Clinical Benefit in HR+/HER2+ Breast Cancer

Commentary
Video

A future phase 2 trial may compare anastrozole plus a CDK4/6 inhibitor and trastuzumab or pertuzumab with chemotherapy plus trastuzumab and pertuzumab in hormone receptor–positive, HER2-positive metastatic breast cancer.

In a conversation with CancerNetwork®, Amy Tiersten, MD, spoke to positive efficacy findings from the phase 1/2 ASPIRE trial (NCT03304080), assessing anastrozole (Arimidex) plus palbociclib (Ibrance), trastuzumab (Herceptin), and pertuzumab (Perjeta) in hormone receptor (HR)–positive, HER2-positive metastatic breast cancer that were presented at the 2023 San Antonio Breast Cancer Symposium (SABCS).

Tiersten, professor of medicine and clinical director of Breast Medical Oncology at Mount Sinai Hospital, said that the experimental regimen produced a clinical benefit rate of 97% (95% CI, 83%-100%), thus meeting the trial’s primary end point. Other data highlighted an objective response rate of 73% (95% CI, 54%-88%) in the experimental arm, which included partial responses in 60% of patients and complete responses in 4%. Additionally, the combination didn’t have any new safety signals, with the toxicity profile being comparable with prior reports of each individual agent.

Following these results, Tiersten said she was interested in initiating a randomized phase 2 trial comparing anastrozole in combination with a CDK4/6 inhibitor and trastuzumab or pertuzumab with chemotherapy plus trastuzumab and pertuzumab, the current standard of care in HR-positive, HER2-positive metastatic breast cancer.

Transcript:

We exceeded our primary end point expectation. The clinical benefit rate was 97%, which was really fabulous. No patients had progressive disease as their best response, and the duration of response was quite long. Toxicity was sort of what would be expected with the known toxicity profiles of the individual agents. Those are the main important data points to take home.

I would love to compare this [combination] to standard frontline therapy for [patients with] hormone receptor–positive, HER2-positive metastatic breast cancer. Currently, the standard of care in the frontline setting is chemotherapy with trastuzumab and pertuzumab. I would foresee the potential for perhaps a phase 2 randomized trial comparing anastrozole with a CDK4/6 inhibitor and trastuzumab or pertuzumab vs a standard chemotherapy such as a taxane plus trastuzumab and pertuzumab. I’d like to look into proceeding with that.

Reference

Patel R, Cascetta K, Klein P, et al. A multicenter, phase I/II trial of anastrozole, palbociclib, trastuzumab, and pertuzumab in hormone receptor (HR)-positive, HER2-positive metastatic breast cancer (ASPIRE). Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX; abstract RF02-01.

Recent Videos
James Ninia, MD, discussed treatment options for patients with extensive-stage small cell lung cancer undergoing metastasis-directed radiotherapy.
Whole or accelerated partial breast ultra-hypofractionated radiation in older patients with early breast cancer may reduce recurrence with low toxicity.
Ultra-hypofractionated radiation in those 65 years or older with early breast cancer yielded no ipsilateral recurrence after a 10-month follow-up.
The unclear role of hypofractionated radiation in older patients with early breast cancer in prior trials incentivized research for this group.
Adding bortezomib to Isa-Rd triplet therapy enhanced MRD-negative responses in patients with transplant-ineligible multiple myeloma.
Isatuximab plus VRd triplet therapy did not significantly increase toxicity in patients with transplant-ineligible multiple myeloma in the IMROZ trial.
Isatuximab quadruplet therapy for patients with multiple myeloma prolonged progression-free survival when compared with VRd triplet therapy.
Retrospective study data show that patients with inflammatory bowel disease may not require modification of standard radiotherapy for pelvic malignancies.
Prospective trial data may help guide treatment planning for patients with inflammatory bowel disease planning to undergo radiotherapy.
Samantha Shenoy, NP, MSN, suggests that support groups may help comfort patients experiencing adverse effects negatively impacting quality of life.
Related Content