Pertuzumab with trastuzumab and docetaxel for treating HER2-positive breast cancer

Pertuzumab (Perjeta, Roche Products) is a monoclonal antibody targeting human epidermal growth factor receptor 2 (HER2). Pertuzumab binds to the HER2 receptor and inhibits intracellular signalling. It is administered by intravenous infusion.

Pertuzumab has a UK marketing authorisation for use 'in combination with trastuzumab and docetaxel in adult patients with HER2 positive metastatic or locally recurrent unresectable breast cancer, who have not received previous anti HER2 therapy or chemotherapy for their metastatic disease'.

The summary of product characteristics lists the following adverse reactions for pertuzumab in combination with trastuzumab and docetaxel: left ventricular dysfunction (including congestive heart failure), infusion reactions, hypersensitivity reactions (including anaphylaxis), neutropenia, febrile neutropenia, leukopenia, diarrhoea, alopecia and rash. For full details of adverse reactions and contraindications, see the summary of product characteristics.

The recommended dose of pertuzumab is an initial loading dose of 840 mg followed every 3 weeks by a maintenance dose of 420 mg in combination with trastuzumab and docetaxel. Treatment with pertuzumab should be continued until disease progression or unmanageable toxicity.

Pertuzumab is £2,395 per 420‑mg vial (BNF 17). Therefore the cost of pertuzumab (excluding VAT) is estimated to be £4,790 for the initial dose and £2,395 for subsequent doses.

The company has agreed a commercial access arrangement for pertuzumab with NHS England. The commercial access arrangement replaces the patient access scheme agreed with the Department of Health for pertuzumab. The details of this commercial access arrangement are commercial in confidence.