Pertuzumab in human epidermal growth-factor receptor 2-positive breast cancer: clinical and economic considerations

Nathan WD Lamond, Tallal YounisDepartment of Medicine, Dalhousie University at the Queen Elizabeth II Health Sciences Centre, Halifax, NS, CanadaAbstract: In the absence of specific therapy, the 15%–20% of breast cancers demonstrating human epidermal growth-factor receptor 2 (HER2) protein overexpression and/or gene amplification are characterized by a more aggressive phenotype and poorer prognosis compared to their HER2-negative counterparts. Trastuzumab (Herceptin), the first anti-HER2-targeted therapy, has been associated with improved survival outcomes in HER2-positive breast cancer. However, many patients with early stage disease continue to relapse, and metastatic disease remains incurable. In order to further improve these outcomes, several novel HER2-targeted agents have recently been developed. Pertuzumab (Perjeta), a monoclonal antibody against the HER2 dimerization domain, has also been associated with improved patient outcomes in clinical trials, and has recently been approved in combination with chemotherapy and trastuzumab for neoadjuvant therapy of early stage, HER2-positive breast cancer and first-line treatment of metastatic disease. This review briefly summarizes pertuzumab's clinical development as well as the published evidence supporting its use, and highlights some of the currently unanswered questions that will influence pertuzumab’s incorporation into clinical practice.Keywords: HER2/neu, clinical trials, drug development, novel therapies, targeted anticancer therap

The Dangers of Disaster-Driven Responses to Climate Change

Low-probability, high-consequence climate change events are likely to trigger management responses that are based on the demand for immediate action from those affected. However, these responses may be inefficient and even maladaptive in the long term

A hedonic modelling of land property value based on the effect of flooding: a case for peninsular Malaysia

The effect of flooding on land property value is a major concern of all landowners. Numerous studies have already discussed the risk of potential decline in the value of land property situated in flood-prone areas; however, those that focused on the impact of flooding on land property in Malaysia are still limited. This chapter investigates the effect of flood on the value of agricultural and industrial land properties in Peninsular Malaysia. This chapter’s results suggest that a metre increase in flood depth significantly decreases land property value by 44.6%. This result helps policymakers in designing and developing the policies of land property development that would minimize land property devaluation due to flood depth and help landowners in understanding the effect of flood on land property values