A new study has revealed that an all-targeted treatment regimen could hold potential as an effective frontline therapeutic option for a type of breast cancer – potentially opening the door to a more convenient and chemotherapy-free option for patients.
In the investigator-initiated, single-arm Phase I/II ASPIRE study (NCT03304080), researchers from the Icahn School of Medicine at Mount Sinai evaluated the potential of a four-strong combination of targeted therapies, including aromatase inhibitor, anastrozole, hormone therapy palbociclib and HER2 blockers, Herceptin (trastuzumab) and Perjeta (pertuzumab) in patients with frontline HR-positive, HER2-positive metastatic breast cancer.
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Of the 29 efficacy-evaluable patients, 97% achieved a clinical benefit from treatment, while the median progression-free survival (PFS) within the study cohort was just under 25 months. Thus far, the quadruplet of medicines is also showing positive trends towards improving overall survival (OS), as median OS was not yet reached at a follow-up of over 39 months.
The combination of anastrozole, palbociclib, Herceptin and Perjeta also demonstrated a consistent safety profile to that expected of the individual medicines, with the most common side effects being low neutrophil levels and anaemia. To date, only one patient in the study has discontinued treatment with these four drugs, with no patient deaths recorded.
Making the shift away from chemotherapy
In recent years, there have been several developments in the oncology space – including the increased reliance on therapies that offer greater tumour-killing specificity than traditional approaches like radiation or chemotherapy.
According to Rima Patel, assistant professor of medicine at the Ichan School of Medicine and first author of the ASPIRE study, targeted treatment approaches such as the quadruplet regimen tested in ASPIRE could be particularly beneficial to breast cancer patients who are not ideal candidates for chemotherapy, such as older adults and those with comorbidities.
“The challenge in treating this type of breast cancer is balancing effectiveness with quality of life,” Patel commented.
“A targeted regimen that can be given primarily through oral medication and subcutaneous injection could offer a more convenient option while reducing some of chemotherapy’s burden,” she added.
Despite these positive results, the researchers caveat that they conducted the study on a small scale, and it did not compare the combination to current standard of care (SoC) approaches in HR-positive, HER2-positive breast cancer. This means that further randomised trials will need to be performed to ascertain the true benefit of this regimen.
In previous conversation with Clinical Trials Arena’s sister publication, Pharmaceutical Technology, experts noted that targeted therapies represent the next frontier in oncology treatment, though the introduction of such options varies dramatically based on indications, payer sentiments and the contextual cost-benefit offering of a specific medicine or regimen.
