First-line Eribulin Plus Trastuzumab and Pertuzumab for Patients With HER2-Positive Locally Advanced or Metastatic Breast Cancer
According to results from the phase 3 EMERALD trial, eribulin plus trastuzumab and pertuzumab demonstrated promising efficacy as a first-line option for patients with human epidermal growth factor receptor 2 (HER2)-positive locally advanced or metastatic breast cancer.
“Trastuzumab-pertuzumab plus taxane-based chemotherapy is a current standard first-line therapy… However, taxane-induced toxicities necessitate development of less toxic but at least equally effective alternatives,” stated Toshinari Yamashita, MD, PhD, Kanagawa Cancer Center, Kanagawa, Japan, and coauthors.
In this open-label study, 446 patients were randomized on a 1-to-1 basis to receive trastuzumab and pertuzumab, with either 1.4 mg/m2 of eribulin on days 1 and 8 (n = 224), or taxane-based therapy (n = 222), until disease progression or unacceptable toxicity. The primary end point was progression-free survival (PFS). Key secondary end points included objective response rate (ORR), overall survival (OS), median time to quality-of-life deterioration, and safety.
At analysis, the median PFS was 14 months in the eribulin arm and 12.9 months in the taxane arm (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.76 to 1.19; P = .68). The ORR was 76.8% in the eribulin arm and 75.2% in the taxane arm and the median OS was not reached in the eribulin arm and 65.3 months in the taxane arm. The median time to quality-of-life deterioration was 7.16 months and 4.57 months, respectively (HR, 0.80; 95% CI, 0.66 to 0.99; P = .08).
Grade ≥3 treatment-related adverse events occurred in 58.9% of patients in the eribulin arm and 59.2% of patients in the taxane arm. Patients in the taxane arm more frequently experienced infusion reactions, skin-related adverse events, diarrhea, and edema, whereas patients in the eribulin arm more frequently experienced neutropenia.
“The present study is the first phase III trial that showed the noninferiority of eribulin to taxane when used with the dual HER2 blockade as first-line systemic treatment for HER2-positive [locally advanced or metastatic breast cancer],” concluded Dr Yamashita et al.
“This study allows individual preferences and toxicity concerns to drive treatment decisions without compromising efficacy,” added Journal of Clinical Oncology Senior Deputy Editor Kathy Miller, MD, Indiana University, Bloomington, Indiana.
Source:
Yamashita T, Saji S, Takano T, et al. Trastuzumab-pertuzumab plus eribulin or taxane as first-line chemotherapy for human epidermal growth factor 2–positive locally advanced/metastatic breast cancer: The randomized noninferiority phase III EMERALD trial. Published online: January 9, 2025. doi: 10.1200/JCO-24-01888
