In a plenary lecture, Dr. Neil L. Spector of Duke University, Durham, N.C., said that if two anti-HER2 drugs are better than one, it’s entirely possible that complete blockade of HER2 via triple therapy with trastuzumab, pertuzumab, and lapatinib would be the most effective of all, albeit with an astronomical price tag.
"Total blockade may be feasible, but we’re going to bust the economy," he argued. "If we’re going to develop these things, and only 5 patients out of 100 can afford them, we have to rethink what the hell we’re doing."
Dr. Spector said that although 15 years ago he was a major skeptic about tumor vaccines, he has recently changed his mind in response to preclinical and early clinical evidence that vaccines now in development can generate good titers of polyclonal antibodies. "What if we could generate trastuzumab- and pertuzumablike antibodies directly in patients, making total HER2 blockade more affordable?" he said. "I think vaccines have come of age."
An ongoing clinical trial at Duke shows evidence that a polyclonal HER2 vaccine in combination with lapatinib provides an enhanced anti-tumor effect, the oncologist added.
The Neo-ALTTO and GeparQuinto trials were supported by GlaxoSmithKline. Dr. Baselga and Dr. Untch declared that they have no relevant financial relationships to disclose.
Correction: An earlier version of this article described imprecisely the CLEOPATRA trial. The trial compares first-line therapies for HER-2 positive metastatic breast cancer.