When to start nerlynx
Use of Neratinib in HER2-Positive Breast Cancer
in the study patients had started in a
rat named who had even been well beyond
six months or sometimes a year from
completion of tries to my base therapy
but it was shown that benefit is greater
in patients who receive it within six
months of completing the trastuzumab a
therapy but not that we have that
knowledge and other view of the results
of the study I think that no one would
deliberately delay the start of
narratives so I would start it within a
few weeks of stopping tries to zoom back
as we know the major side effect of
narrator name was diarrhea in fact in
the pivotal trial presented by dr. Lin
Chen there was 40 percent grade 3
diarrhea and later on it became apparent
that prophylaxis with loperamide would
drastically cut down the diarrhea rate
and there has been a subsequent study
called the control trial using
loperamide initially and the second
phase adding other agents such as
cholestyramine and beresan I'd so the
idea rates can be cut very drastically
just with loperamide at 16 milligrams
total dose daily which has brought down
to about 6 milligrams
subsequently within the first month and
then PR and use with the second month
onwards cuts such diarrhea rates from 40
percent down to about 17 percent or in
the teens so i think that once we learn
to manage diarrhea we can really give me
a retina without much concern to these
patients we have to educate our patients
we have to educate ourselves and I think
going forward it would not be as much of
a problem the other important thing to
remember is that this diarrhea is of
short duration and the incidence really
drops after the first cycle there's a
tachyphylaxis of sorts tuna retina by
the GI tract so those two things are
important to highlight that this is not
the diarrhea that somebody can have for
a month every
duration of severe diarrhea was two to
three days
