Dr. Tripathy on the NALA Trial in HER2+ Breast Cancer With Brain Metastases

Debu Tripathy, MD, professor, chairman, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the implications of results from the phase 3 NALA trial (NCT01808573) in patients with HER2-positive metastatic breast cancer with brain metastases.

NALA explored the use of neratinib (Nerlynx) plus capecitabine (Xeloda) vs lapatinib (Tykerb) and capecitabine in patients with HER2-positive metastatic breast cancer who received 2 or more HER2-directed regimens in the metastatic setting. Among patients who had central nervous system (CNS) metastases at baseline, the median progression-free survival (PFS) was 7.8 months in the neratinib arm compared with 5.5 months in the lapatinib arm. Notably, the CNS progression-free survival was 12.4 months in the neratinib arm vs 8.3 months in the lapatinib arm.

The use of TKIs, particularly in an early setting, could reduce the number of patients who develop CNS disease, Tripathy says. In addition to data from the NALA trial, extended follow-up from the phase 2 HER2CLIMB trial (NCT02614794) could also support that notion, Tripathy adds.

Additional trials are exploring the effects of agents on patients with brain metastases. Ultimately, improving outcomes for patients with CNS disease will remain a priority, Tripathy concludes.