Pyro show.

Building off phase 1 data, this phase 3 trial compares the irreversible pan-HER blocker pyrotinib against the more standard lapatinib when either is given in conjunction with capecitabine for metastatic HER2+ breast cancer refractory to first-line trastuzumab. Among the 267 enrollees, the primary endpoint of progression-free survival was nearly doubled with pyrotinib from 7 to 13 months, while overall survival data remains immature. Granted this came at the cost of nearly quadruple the rate of grade 3+ diarrhea at 8% versus 31%. The question now becomes which is better, pyrotinib or TDM-1—a question that may eventually bleed over to adjuvant systemic therapy recs for non-complete responders to neoadjuvant trastuzumab. | Xu, Lancet Oncol 2021