Kadcyla for cancers other than breast

Kadcyla (ado-trastuzumab emtansine) was recently approved for the treatment of breast cancer. It is targeted against HER2. HER2, a protein which drives normal cell growth, is found in different cancer types, including breast cancers, and is also the target for two other common breast cancer drugs: Herceptin and Tykerb.

Kadcyla is a compound drug. Kadcyla, previously called T-DM1,  is trastuzumab connected to a drug called DM1 that interferes with cancer cell growth.

The approval was based on the EMILIA study that tested Kadcyla against Xeloda and Tykerb. Those in the Kadcyla group survived progression-free for 9.6 months  whereas those in the lapatinib plus capecitabine group survived only 6.4 months progression-free. Patients in the Kadcyla group had a median overall survival of 30.9 months while in the lapatinib plus capecitabine group, median overall survival was 25.1 months.

Because the HER2 receptor is expressed so widely in other cancers and not only breast, the temptation is to use it whenever HER expression is found. However,this concept needs to be studies. Kadcylar us not an innocuous drug. Side effects of vomiting, diarrhea, and stomatitis are more common in those who sue this drug. Kadcyla carries black box warnings for liver toxicity, heart damage (reduction in left ventricular ejection fraction), and fetal harm if given to pregnant women.

One question remains: When they came up with this name, did they think of Godzila? Does size matter?

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