title: Management of patients treated with pertuzumab in the Australian clinical practice setting.
abstract: OBJECTIVE
  Treatment with pertuzumab-trastuzumab-taxane combinations has become the international standard of care for patients with HER2-positive metastatic breast cancer. In this paper we discuss the practicalities of treating patients with this combination with a particular focus on treatment in the Australian setting.
  
  
  METHODS
  An expert panel was convened to discuss practical aspects for use of pertuzumab in the Australian clinical setting. The findings of this panel are reported in this article.
  
  
  RESULTS
  The combination of pertuzumab-trastuzumab-docetaxel has established efficacy in patients with HER2-positive metastatic breast cancer, prolonging progression-free and overall survival compared to trastuzumab-taxane combinations. In Australia, combinations of pertuzumab and trastuzumab with docetaxel or paclitaxel are reimbursed. Management of treatment related side-effects such as diarrhea, febrile neutropenia and neuropathy typically include dose reduction or switching taxane. Specific patients with poorer tolerance of chemotherapy such as the elderly or those from Asian backgrounds may require particular management strategies.
  
  
  CONCLUSIONS
  The advent of targeted therapies for women with metastatic HER2-positive breast cancer has markedly improved survival. Combinations of pertuzumab-trastuzumab and a taxane are the standard of care in patients with good performance status. Given prolongation of survival and the importance of quality of life endpoints, the treatment paradigm for patients with metastatic HER2-positive breast cancer is changing rapidly. Careful management of toxicities is required, and dose reduction or switching taxane may be necessary. Further research is required on the efficacy of pertuzumab combinations in patients with brain metastases, and on those who relapse quickly following adjuvant therapy.
authors.affiliation: Mater Health Services / Mater Research Institute, Raymond Terrace, Queensland, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Woodward
authors.affiliation: Monash Health, East Bentleigh, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: White
authors.affiliation: Poche Centre, North Sydney, New South Wales, Australia.
authors.forename: Lina
authors.initials: L
authors.lastname: Pugliano
authors.affiliation: St John of God Subiaco Hospital, Subiaco, Western Australia, Australia.
authors.forename: Daphne
authors.initials: D
authors.lastname: Tsoi
authors.affiliation: Roche Products Ltd, Dee Why, New South Wales, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Ryan
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000737:chemistry; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001315:Australia; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D019468:Disease Management; D018450:Disease Progression; D000077143:Docetaxel; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000201:enzymology / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis; D043823:Taxoids / Q000008:administration & dosage; D000068878:Trastuzumab / Q000008:administration & dosage
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D001952:Bridged-Ring Compounds; D000077143:Docetaxel; D017239:Paclitaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C080625:taxane; C508053:ERBB2 protein, human; C485206:pertuzumab
keywords: ErbB-2; breast neoplasms; metastasis; pertuzumab; receptor; toxicity