Would you use neratinib in a very-high risk Her-2 positive breast cancer patient who is ER-?

ExteNET trial of neratinib, given for one year after completion of adjuvant trastuzumab, showed a small improvement in DFS. No OS benefit. HR-positive patients derived most of this small DFS benefit. I don’t think HR-negative patients will benefit at all. But for patients who are at incredibly high risk of cancer recurrence, and are HR-positive, the marginal DFS benefit maybe real. I think we must await OS data before it’s widely used in patients who are at high risk. Another aspect that is concerning is the significant toxicity (diarrhea). The risk for diarrhea can be reduced by prophylactic use of anti-diarrheals.

No