Pertuzumab-Trastuzumab Combo Increases Infusion Reaction Risk in Breast Cancer

M. Alexander Otto, MMS, PA

March 10, 2022

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Patients with HER2-positive breast cancer who receive pertuzumab (Perjeta) and trastuzumab (Herceptin) on the same day had a significantly greater incidence and severity of infusion reactions compared with those receiving trastuzumab monotherapy.

  • Patients with high baseline lymphocyte counts are particularly at risk. 

Why This Matters

  • The findings can help clinicians tailor combination therapy to reduce the risk of infusion reactions.

  • A patient's lymphocyte count may indicate the use of prophylactic antipyretic.

Study Design

  • The team compared infusion reaction rates in 65 patients with breast cancer receiving pertuzumab and trastuzumab 60 minutes apart to rates in 106 patients given trastuzumab alone.

Key Results

  • The incidence of infusion reactions was 47.7% (n = 31) with the combination therapy vs 18.9% (n = 20) with trastuzumab monotherapy.

  • Over one third of patients on combination therapy had grade 2 reactions vs 4% in the monotherapy group.

  • Median lymphocyte count (103/μL) was 1.68 among patients who had an infusion reaction vs 1.20 among those who did not (P = .029).

  • A previous trial found no increase in infusion reactions with the combination, but pertuzumab and trastuzumab were administered a day apart. 

Limitations

  • Higher body mass index and cancer stage both affect the risk of infusion reactions, but these factors were not addressed in the analysis.

  • The background characteristics of patients in the infusion reaction and non-infusion reaction groups were not standardized.

  • Infusions were mostly outpatient, so at-home reactions might have been missed.

  • The study was conducted in Japan, which might limit generalizability.

Disclosures

  • There was no funding for the work.

  • Two investigators had ties to Chugai Pharmaceutical Co.

This is a summary of a preprint research study, "Incidence and Risk Factors of Infusion Reactions in Breast Cancer Patients Administered Pertuzumab Combination Chemotherapy," led by Yusuke Tabuchi of Kyoto Pharmaceutical University, Japan. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and is also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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