Dr. Lin on CNS-Specific Outcomes With Neratinib in HER2+ Breast Cancer

Nancy U. Lin, MD, associate professor of medicine, Harvard Medical School, associate chief, Division of Breast Oncology, Susan F. Smith Center for Women’s Cancers, director, Metastatic Breast Cancer Program, and senior physician, Dana-Farber Cancer Institute, discusses central nervous system (CNS)—specific outcomes with neratinib (Nerlyx) in HER2-positive breast cancer.

Pooled CNS data from the NALA, NEfERT-T, and TBCRC 022 trials highlight the efficacy of neratinib in patients with HER2-positive breast cancer that is metastatic to the brain, explains Lin. In the TBCRC 022 trial, which only enrolled patients with progressive brain metastases, the objective response rate (ORR) in the brain was 49% in lapatinib (Tykerb)-naïve patients; among those who received lapatinib, the CNS ORR was 33%.

Patients in the NALA and NEfERT-T trials either had stable or treated brain metastases; they couldn't have progressive brain metastases at the start of the trial, says Lin. As such, the data focused on time-to-event outcomes. Both trials showed an extended time to CNS events with the combination of neratinib and capecitabine. In the NEfERT-T trial, the total incidence of CNS metastases was 20% in the trastuzumab (Herceptin)/paclitaxel arm compared with 10% in the neratinib/paclitaxel arm, concludes Lin.