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The future of anti-HER2 therapy lies in "combination" therapy more than from just relying on compounds such as Kadcyla, or Herceptin, or Tykerb or Perjeta. It is the good outcome of the patient not the therapy applied that constitute successful application of medicine. We can still hope for a good outcome if you use all the available drugs at our disposal that best meet the needs of the patient.
And relying on a companion diagnostic to identify cancer patients with HER2-positive metastatic cancer who "may" be eligible just for Kadcyla treatment is ambiguous. It examines "dead" tissue that is preserved in paraffin or formalin. which ruins sequencing capabilities, denatures everything and ruins the sample.
How is that going to be predictive to the behavior of your "living" cells in spontaneously formed colonies in the body? No gene-based test can discriminate differing levels of anti-tumor activity occurring among different targeted therapy drugs. Nor can it identify situations in which it is advantageous to combine a targeted drug with other types of cancer drugs.
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