Adherence and patients' attitudes to oral anticancer drugs: a prospective series of 201 patients focusing on targeted therapies.

OBJECTIVES: Patient adherence is a challenge in oncology and hematology practice. Hormone therapy data in breast cancer suggest insufficient adherence and poor persistence. Limited data are available for targeted therapies (TT) including tyrosine kinase and mammalian target of rapamycin inhibitors. METHODS: We performed a prospective survey using a 15-item questionnaire in patients with solid tumors and hematologic malignancies receiving oral anticancer therapy. Treatment duration, setting (adjuvant vs. metastatic), cancer type, age, and comedication were recorded. RESULTS: 201 patients (median age 65.5 years) participated, 102 with TT and 99 with hormone therapy or chemotherapy (HC). The median time of drug intake was 11.0 months. Written information was more frequently given to TT patients (68.6 vs. 23.2%, p < 0.0001). TT and HC patients showed equal adherence to therapy (72.5 vs. 69.6%, p = n.s.) despite TT patients experiencing more side effects (p < 0.0001) and taking more concomitant oral medication (p = 0.0042). Forgotten doses were the leading cause of nonadherence in HC patients (83%, as compared to 54% in the TT group), whereas dose reduction by the patient was higher in the TT group (32 vs. 17%). CONCLUSIONS: Despite advances in providing information to patients leading to better adherence among TT patients, efforts towards better patient education are warranted including dedicated staff for monitoring outpatient anticancer oral therapy.

Pertuzumab: development beyond breast cancer.

Pertuzumab (Perjeta®) represents the first monoclonal antibody in a new class of agents known as dimerization inhibitors. Pertuzumab was recently approved for the treatment of Human Epidermal Receptor 2 (HER2)-positive breast cancer in the metastatic and neo-adjuvant setting. This approval for first-line therapy for metastatic breast cancer was based on the results of a large randomized multicenter phase III trial showing a significant improvement in overall survival when pertuzumab was combined with trastuzumab and docetaxel in HER2-positive metastatic breast cancer. In the neoadjuvant setting, dual HER2 blockade by trastuzumab and pertuzumab improved the complete pathological response rate. However, pertuzumab development was not confined to breast cancer and in the present article, we focus on pertuzumab data for solid tumors other than breast cancer, and review the biological rationale for its use, the published pre-clinical and clinical evidence, as well ongoing trials.