APHINITY Trial in HER2 Positive Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Updated results from the adjuvant APHINITY trial in HER2-positive early breast cancer:
    • Now with a median follow-up of 10.4 years:
      • Confirmed the benefit of adding pertuzumab to trastuzumab plus chemotherapy:
        • In preventing invasive disease recurrences, but as yet no statistically significant overall survival benefit has emerged
  • The long-term outcomes of both arms remain very good:
    • With more than 92% of patients alive at 8 years:
      • The overall survival analysis remains immature:
        • But the difference of 0.7% numerically favors the pertuzumab arm
  • Key Findings of Aphinity trial:
    • In the third interim analysis, fewer deaths were seen in the pertuzumab arm compared with the placebo arm:
      • By January 10, 2022, deaths totaled 168 in the pertuzumab arm (7.0%) and 202 in the placebo arm (8.4%)
      • The 8-year overall survival percentages were 92.7% vs 92.0%, respectively – a 0.7% difference (hazard ratio [HR] = 0.83; P = .078; 95% confidence interval [CI] = 0.68–1.02)
    • For invasive disease–free survival, the primary endpoint:
      • The updated descriptive analysis revealed a 2.6% absolute benefit for pertuzumab (HR = 0.77; 95% CI = 0.66–0.91):
        • Consistent with the 2.8% increase from the 6-year analysis, she further reported
    • Of note, the sustained benefit with pertuzumab was driven by its impact on the node-positive cohort:
    • The absolute benefit of dual HER2 blockade in this cohort was 1.9% for overall survival and 4.9% for invasive disease–free survival
    • In contrast, patients with node-negative disease derived no additional benefit:
      • From the second anti-HER2 agent
    • Interestingly, although not shown in previous analyses:
      • The addition of pertuzumab conferred an advantage in both hormone receptor negative and positive patients
  • Two key takeaways from the latest findings:
    • The node-positive cohort derives benefit from adding pertuzumab
    • And with longer follow-up beyond the first 3 years, the data clearly show that hormone receptor status should not guide pertuzumab treatment decisions
  • REFERENCES
    • Loibl S, Jassem J, Sonnenblick A, et al: Updated results of APHINITY at 8.4 years median follow-up. ESMO Virtual Plenary. Abstract VP6-2022l. Presented July 14, 2022.
    • Piccart M, Procter M, Fumagalli D, et al: Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer in the APHINITY Trial: 6 years’ follow-up. J Clin Oncol 39:1448-1457, 2021.
    • Von Minckwitz G, Procter M, de Azambuja E, et al: Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. N Engl J Med 377:122-131, 2017.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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