Is there a role for extended adjuvant neratinib with pCR after neoadjuvant chemotherapy in triple positive breast cancer?

The benefit of adjuvant neratinib is generally proportional to the residual risk of recurrence following definitive therapy including HER-targeted adjuvant therapy. In the ExteNET study final efficacy report, the absolute difference in overall survival at 5 years was estimated at 9.1% in 295 patients with hormone receptor-positive disease who received neratinib < 1 year after completion of adjuvant trastuzumab and had residual disease after neoadjuvant therapy (1). Therefore, in patients who achieved a pCR, I would be less included to use adjuvant neratinib, but it could still be discussed in the context of the projected small benefit traded off against the side effects (and financial toxicities issues if these apply as well). In addition t...