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Thursday, March 22, 2018


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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  • Nice study with over 2800 patients. Having 100 patients take a pill for a year with 40% incidence of diarrhea for 2.5 to potentially benefit seems to me that whereas the study has significant incidence its relevance is questionable.. Does leave the door open for other EGFR blockers in future.

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