HER2 Support Group Forums - Adjuvant Perjeta/pertuzumab

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Adjuvant Perjeta/pertuzumab

This discussion started over on SpiritualAbundance's TCH/hair&nail thread but I think it deserves its own thread.

I saw people posting that she should check into Perjeta. The last I had paid attention, it was FDA-approved in the US only for neoadjuvant (before surgery) or metatstatic use. When I googled a bit to try and find out if this is still true, it seems it is (even Perjeta website only lists the two indications).

BUT, I also found this from NCCN last year. NCCN guidelines carry a lot of weight in the US, and I would think would be a strong statement to show both reluctant oncs and insurance companies:

The Panel noted, “Considering the unprecedented improvement in overall survival in the metastatic setting and the significant improvement in pathologic complete response seen in the neoadjuvant setting, the NCCN Panel considers it reasonable to incorporate pertuzumab in … adjuvant regimens, with duration similar to that used in the neoadjuvant setting, if the patient did not receive pertuzumab as part of neoadjuvant therapy.” Pertuzumab may also be part of neoadjuvant treatment in patients with ≥ T2 or ≥ N1 disease."

The above is from this ASCO article

I can't copy/paste from the actual guidelines, but they do include that last sentence as a footnote on their HER2+ (both ERPR negative and triple positive) page.

Does anyone have more current or accurate info on adjuvant Pertuzumab?

Debbie L.

Re: Adjuvant Perjeta/pertuzumab

Thanks so much for starting this thread, Debbie! It seems like the parameters for use are changing ... probably because it is still a relatively new drug. Mostly (from my perspective) I had seen it mentioned in several protocols lately ... and for someone new who is looking for info, you want to make sure you mention anything that might be of benefit.

I know I asked my oncologist (after my chemo was over) why I hadn't qualified for it, and he thoroughly explained it. But, I was diagnosed at a different Stage, etc, all of which makes a difference in determining the course of treatment.

Thanks again! I am so grateful to be on this board with all of you!

Carol Ann

Re: Adjuvant Perjeta/pertuzumab

I received adjuvant perjetta. There was no problem getting my insurance to pay. The Onc did a prior authorization but no difficulty at all, even though it say neoadjuvant. This is because of the clnical trials were done in the neoadjuvant setting, but does not mean it is less effective adjuvant.
So yes it is being done in the adjuvant setting.

Re: Adjuvant Perjeta/pertuzumab

I was given neoadjuvant Perjeta starting in January 2015. I was Stage 2b, Grade 3, with one lymph node known to be involved. My chemo was TCHP, six rounds. I finished in May and had a bilateral mastectomy in June with one of nine nodes positive; which an earlier biopsy had already shown. It had greatly reduced the size of the tumor in my breast and the one in my lymph node although I did not have a" complete" response. I am now completing my year of just Herceptin. There was no question from the very beginning that Perjeta would be a part of my chemo and fully covered by my insurance. I had the option for neoadjuvant or adjuvant chemo and it would be the same simply because I am Her2 positive. It was not based on the lymph node involvement.

Re: Adjuvant Perjeta/pertuzumab

I also had it in the adjuvant setting.