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