This 5-question pulse of 24 oncologists practicing in the United States focuses on the usage of HER2-targeted agents for the treatment of breast cancer. Although Herceptin (trastuzumab) remains the mainstay of treatment in all settings for patients with HER2-positive disease, Genentech/Roche is pushing forward with clinical trials for Perjeta (in combination with Herceptin) and Kadcyla as Herceptin's patent expiration dates loom closer. Roche hopes to position Kadcyla as a less-toxic alternative to Herceptin + chemotherapy in the first-line metastatic setting (MARIANNE trial) and Perjeta as an add-on to Herceptin in patients with early breast cancer.

Meanwhile, Puma Biotechnology (PBYI) hopes to gain approval for its irreversible EGFR/HER2 inhibitor neratinib, which the sponsor licensed from Wyeth/Pfizer. This agent reduces disease recurrence rate for some early-stage breast cancer patients in the post- Herceptin adjuvant setting. An approval for Puma in this setting will allow the company to gain a foothold in a market that GSK sought to break into with Tykerb (lapatinib), another oral EGFR/HER2 TKI that is used primarily in the metastatic setting.

Furthermore, we provide a comparison with physician views on many of these agents from an April 2014 pulse.

The following drugs are discussed in this pulse:

• Neratinib (PBYI)
• Herceptin (trastuzumab, Roche)
• Perjeta (pertuzumab, Roche)
• Kadcyla (trastuzumab-DM1, Roche)
• Tykerb (lapatinib, GSK)

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