# APHINITY: adjuvant pertuzumab added to trastuzumab and chemotherapy in early HER2-positive breast cancer

Source: https://onco.cc/key-papers/paper-aphinity-nejm-2017/  
OnCo record `paper-aphinity-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding a second HER2 antibody, pertuzumab, to a year of trastuzumab after surgery reduced recurrences modestly in early HER2-positive breast cancer, with the gain concentrated in women with lymph node involvement.

## Summary

Phase 3 placebo-controlled trial of 4,805 patients with operable HER2-positive breast cancer randomised to chemotherapy plus trastuzumab with pertuzumab or placebo for one year.

Three-year invasive disease-free survival was 94.1 percent with pertuzumab against 93.2 percent with placebo (hazard ratio 0.81); in node-positive disease the absolute gain grew to 4.5 percent at six years, with no benefit seen in node-negative disease. Diarrhoea was the main added toxicity.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1703643
- Authors: von Minckwitz G, Procter M, de Azambuja E, et al.
- Findings: Three-year invasive disease-free survival 94.1 percent vs 93.2 percent; hazard ratio 0.81.; Node-positive subgroup: six-year invasive disease-free survival 87.9 percent vs 83.4 percent.
- What it means: Dual HER2 blockade after surgery is reserved for node-positive or otherwise higher-risk disease, where the benefit is real but small; node-negative patients can be spared the extra drug.
- Caveats: Absolute benefit is small and no overall survival difference has emerged.; Trial predates neoadjuvant therapy as the usual route for stage II to III disease.

## Sources

- N Engl J Med 2017: https://doi.org/10.1056/NEJMoa1703643
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28581356/

## Connected records

- cancers: [Early HER2-positive breast cancer](https://onco.cc/cancers/her2-positive-early-breast-cancer/)
- drugs: [Pertuzumab](https://onco.cc/drugs/pertuzumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- trials: [APHINITY](https://onco.cc/trials/aphinity/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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