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The PERSEPHONE trial showed six months of trastuzumab after surgery is as good as twelve, halving the drug cost; no company will run such trials, so public funders and charities must.
PERSEPHONE (Earl et al., Lancet 2019) randomised 4,089 women with HER2-positive early breast cancer to six or twelve months of adjuvant trastuzumab and found four-year disease-free survival of 89.4% versus 89.8%, meeting non-inferiority, with less cardiotoxicity. Adjuvant durations for checkpoint inhibitors (one year), CDK4/6 inhibitors (two to three years) and PARP inhibitors (one year) were set without duration-finding studies. A dedicated de-escalation trial fund, on the model of the UK National Institute for Health and Care Research that paid for PERSEPHONE, would test the highest-spend adjuvant regimens.
Shares Incentives reward me-too drugs and marginal gains, Cancer Research UK, Trastuzumab, Trial design, endpoints and cost.
Shares Incentives reward me-too drugs and marginal gains, Cancer Research UK, Prices and value, National Cancer Institute (NIH).
Shares Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Olaparib, Prices and value, Pembrolizumab.
Shares Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Prices and value, Trastuzumab, Pembrolizumab.
Shares Wrong doses, Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Prices and value, Pembrolizumab.
Shares Wrong doses, Incentives reward me-too drugs and marginal gains, Prices and value, Pembrolizumab.
Shares Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation, Prices and value, Trastuzumab, HER2-positive breast cancer.
Shares PERSEPHONE, Trastuzumab, HER2-positive breast cancer.