Roche's ( OTCQX:RHHBY ) Aphinity trial of Perjeta will affect not only the fortunes of the Swiss company's breast cancer franchise but also could determine whether the upstart Puma Biotechnology ( PBYI ) has much of a future at all. Expectations are high for this trial, testing Perjeta in combination with Herceptin and chemotherapy in post-surgical patients, and a substantial part of Perjeta's $5bn peak sales forecast must be ascribed to its success. Conversely, Puma's neratinib, which is seeking regulatory approval in a broadly similar setting, could be rendered irrelevant by Aphinity because of Perjeta's shorter treatment duration and lower toxicity. Extending the franchise Perjeta is already US-approved in combination with Herceptin in metastatic disease, and earned accelerated approval in the pre-surgical, or neoadjuvant, setting, where it has been shown to reduce the size of tumors before procedures.