Dr. Kalinsky on CNS Involvement in HER2+ Breast Cancer

Kevin Kalinsky, MD, MS, assistant professor of medicine, Division of Hematology and Oncology, NewYork-Presbyterian Hospital/Columbia University Medical Center, discusses central nervous system (CNS) involvement in patients with HER2-positive breast cancer.

There are 2 important unmet needs in HER2-positive disease, Kalinsky says. The number 1 challenge is the rates of CNS involvement. About 50% of patients will have disease that is controlled by the rest of the body, but CNS remains a “sanctuary site.” There has been a lot of focus in recent years on drugs trying to manage CNS involvement. This is something that Kalinsky says needs to be addressed immediately, but researchers hope that neratinib (Nerlynx), a drug that is FDA approved for patients with early-stage disease following postoperative trastuzumab (Herceptin), can move in the right direction.

The other unmet need is the precise role of immunotherapy. Checkpoint inhibitors have shown promise in HER2-positive disease, but where they fit into treatment and their capability of producing long-term responses remains to be seen.