Krispy KRISTINE.

With recent astronomical advancements in the treatment of HER2(+) breast cancer, oncologists are starting to wonder if we can keep the sweet survival benefits but hold the weighty side effects. We're bringing you brand new data (HOT NOW) from the KRISTINE trial designed to test whether pathologic complete response (pCR) rates were better with neoadjuvant pertuzumab + trastuzumab-emtansine (aka TDM1, aka Kadcyla...its still finding itself) compared to the standard regimen of docetaxel, carboplatin, trastuzumab, and pertuzumab (aka TCHP). The hope was to de-escalate the intensity of neoadjuvant chemotherapy while preserving response rates. While pCR rates were pretty sweet in both groups, it was significantly higher with the traditional TCHP (55%) compared to pertuzumab+TDM1 (44%). On the other hand, side effects were much heavier with TCHP in terms of grade 3-4 toxicity (64% versus 13% with dual HER2-blockade alone) and serious adverse event (29% versus 5% with dual HER2-blockade alone). Only longer follow-up will tell how these pCR rates translate into survival outcomes. Until then, it looks like we can’t have our doughnut and eat it too.