Peter Beitsch, MD/

Two Years of Adjuvant Therapy for Patients with Her2+ Cancer, Do I Hear Three?

Neratinib (oral tyrosine kinase inhibitor - dual blockade of HER2 and EGFR kinases) for 1 year AFTER neo/adjuvant chemo/trastuzumab - so 2 years total of therapy - improves invasive disease free 5 yr survival vs placebo 90.2% vs 87.7% (absolute 2.5%).  Will that translate into overall survival - its not clear.  Is that enough of a clinical improvement to warrant a YEAR of therapy...I'm sure that depends on the patient.  A safety update showed that, without diarrhea prophylaxis, the most common grade 3 or 4 adverse events in the neratinib vs placebo groups were diarrhea (40% vs 2%), vomiting (3% vs < 1%), and nausea (2% vs < 1%). Serious adverse events occurred in 7% vs 6% (damn placebo pills).

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