This news release describes the effects a new drug, neratinib, had on a very small subset of patients with metastatic HER2+ positive breast cancers. Neratinib (marketed as Nerlynx) very recently received FDA approval as an add-on treatment for early stage HER2+ positive cancer, but this information was left out of the release. In fact, the release refers to neratinib as an “experimental” drug. It was also confusing as to what was being highlighted in the release. The first part describes the results of a 16-patient clinical trial for which only five patients showed a “meaningful clinical response” (no details were given on what that meant), but the second part of the release describes a new screening tool used to recruit subjects into the clinical trial. It was concerning that the release didn’t talk about the limitations of the clinical trial results, disclose the lead authors’ numerous financial ties with the drug maker, discuss costs associated with the drug, or describe any side effects. In the end, despite its optimistic tone and claim of novelty, the release doesn’t provide much information on progress towards treating this type of cancer.
Metastatic breast cancer patients have limited treatment options. Touting such limited effects of a drug in a small phase 2 trial does little to help inform patients seeking better treatments.
There was no mention of cost in this release. Neratinib (marketed as Nerlynx) was approved July 17, 2017 for the treatment of early-stage HER2+ breast cancer so cost estimates should be available.
The release mentioned that about five patients in the trial had a “meaningful clinical response showing significant disease stabilization or regression,” but did not provide any details as to what that means in patients with metastatic disease.
The release irresponsibly speculates, based on extrapolated (not actual) data about how many people with metastatic breast cancer with the “new mutation” could benefit from the drug.
“The number of patients who could potentially benefit from this new treatment approach is estimated to be in the thousands. The researchers estimate that as many as 200,000 patients are likely to be living with metastatic breast cancer today in the United States. Based on the estimate that the new mutation is present in 2 to 3 percent of cases, the researchers calculated that approximately 4,000 to 6,000 patients with metastatic breast cancer carry a HER2 mutation and are therefore potential candidates for neratinib treatment.”
Remember, these estimates in the thousands are based on a study of just 16 people.
No side effects of the drug were mentioned. It was also glossed over that most of the patients in the trial did not seem to have any response to neratinib. The release’s only reference to harms was that “Neratinib was well tolerated by most patients.” Other research (including the peer-reviewed paper this release is based on) has shown diarrhea to be a significant side effect of neratinib.
This was a small phase 2 clinical trial of 16 women with HER2+ metastatic breast cancer — only five of whom had some “response” to the drug. The small size and modest result are limitations that should have been noted in the release.
The release did not appear to commit disease mongering.
The release didn’t name funders or discuss any potential conflicts of interest, instead referring readers to the full study, for which a journal subscription is required. The published study on which the release is based does list the full funding sources and the study authors’ conflicts of interest. Puma Biotechnology Inc, the maker of neratinib, was one of the study funders. This should have been disclosed in the release. All three corresponding authors of the study have multiple financial ties with Puma Biotechnology and other pharmas. This, too, should have been noted in the release.
No alternatives were compared in this study although the study authors mentioned that this drug was aimed at those women who did not respond to conventional therapies to treat HER2+ cancers.
The release didn’t make it clear that more research is needed following the phase 2 trial. The release could have mentioned that neratinib has already been approved by the FDA for women with early-stage HER2+ breast cancers as a follow-on therapy.
The release made it seem that neratinib was an experimental drug that could be used for women with a particular gene mutation related to HER2+ metastatic breast cancer. It wasn’t made clear that neratinib is already used to treat early-stage HER2+ breast cancer.
No sensational language here. But with only five patients (out of 16) showing a response to neratinib, the release seems to inflate the study results.