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CNS Metastases Remain Unmet Need in HER2+ Breast Cancer

Angelica Welch
Published: Tuesday, Aug 14, 2018

Kevin Kalinsky, MD

Kevin Kalinsky, MD

The rate of central nervous system (CNS) involvement is the most significant unmet need in the management of patients with HER2-positive metastatic breast cancer, according to Kevin Kalinsky, MD.

East, Kalinsky, assistant professor of Medicine, Division of Hematology and Oncology, NewYork-Presbyterian Hospital/Columbia University Medical School, discussed the current treatment landscape of metastatic HER2-positive breast cancer, the potential for immunotherapy, and what is on the horizon for patients in this population who develop brain metastases.

OncLive: Please Provide an overview of your lecture on metastatic HER2-positive breast cancer.

Kalinsky: We spoke about HER2-positive metastatic breast cancer and the significant advances that have been made in this disease. We reviewed the drugs that had been approved, including the monoclonal antibodies like pertuzumab (Perjeta) and ado-trastuzumab emtansine (T-DM1; Kadcyla). Then, we focused on some new therapies coming down the pike that are pretty exciting.

We broke out the talk into different classes of drugs. This included neratinib, which is not yet approved in metastatic HER2-positive breast cancer, but there is some early brain penetration data with it. We also discussed tucatinib, which is a next-generation selective HER2 tyrosine kinase inhibitor that is currently in a randomized phase II trial. Then, we spoke about some exciting monoclonal antibodies that were reported about at the 2018 ASCO Annual Meeting, which showed very significant responses. For instance, there is DS-8201a, which has fast track designation from the FDA. Then, we concluded with the role of immunotherapy, and some early data presented at the 2017 San Antonio Breast Cancer Symposium.

How has treatment for HER2-positive metastatic breast cancer evolved over the last 2 years?

It has significantly changed based upon the results of the CLEOPATRA study, which showed a nearly 15-month OS advantage giving pertuzumab upfront with trastuzumab with docetaxel. We also spoke about the EMILIA study which compared T-DM1 versus capecitabine plus lapatinib (Tykerb) in the second-line setting. There was an OS advantage in that study also. These data have changed the landscape of how we initially treat patients with HER2-positive disease.
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