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This combination therapy consists of two HER2-targeted monoclonal antibodies, pertuzumab and trastuzumab, administered intrathecally for the treatment of HER2-positive breast cancer brain metastases. Pertuzumab (Perjeta) binds to the dimerization domain (domain II) of the HER2 protein, preventing it from pairing with other HER family members, while trastuzumab (Herceptin) binds to domain IV. Together, they provide a more comprehensive blockade of HER2 signaling and promote antibody-dependent cellular cytotoxicity (ADCC). This specific investigation, led by Dr. Kimberly Blackwell at Duke University, explores the safety and efficacy of direct cerebrospinal fluid delivery via lumbar puncture to overcome the limited blood-brain barrier penetration of these biologics when administered intravenously.
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