Julia White, MD
An investigation of the tyrosine kinase inhibitor lapatinib (Tykerb) plus whole-brain radiotherapy has entered into a phase II trial in the treatment of patients with brain metastases from HER2-positive breast cancer.
The researchers are specifically evaluating the use of stereotactic radiosurgery (SRS) in this setting, which is a specialized type of radiation therapy that delivers a single, high dose of radiation directly to the tumor. This method may kill more tumor cells and cause less damage to normal tissue.
Lapatinib halts the growth of tumor cells by blocking some of the enzymes needed to stimulate that growth.
“The long-standing treatment for brain metastases is radiotherapy issued to the whole brain, and now there's SRS that just targets the cancer itself with conformal radiation,” said Julia White, MD. “So this is a question really asking that if we add lapatinib to these patients together with their radiation, can we extend cancer control in their brain.”
In an interview with OncLive
, Julia White, MD, professor of Radiation Oncology, Ohio State University, discussed this ongoing phase II trial, the toxicity profile of the treatment, and the potential for control of these brain metastases.
OncLive: Can you give an overview of the ongoing phase II study of whole-brain radiotherapy with concurrent lapatinib in patients with brain metastases from HER2-positive breast cancer?
: The RTOG1119 clinical trial is really trying to ask a question for HER2-positive patients who have brain metastases, and that is: does adding lapatinib to brain radiation improve their cancer control in the brain? As we know, there's a lot of good news in HER2-positive metastatic breast cancer in that we have an increasing number of agents that extend progression free (PFS) and overall survival (OS), but there's still a high rate of failure in the brain for HER2-positive breast cancer patients. A significant portion of them actually die from central nervous system (CNS) progression, so it's clear that we need better strategies for managing brain metastases for HER2-positive breast cancer patients.
The long-standing treatment for brain metastases is radiotherapy issued to the whole brain, and now there's stereotactic radio surgery (SRS) that just targets the cancer itself with conformal radiation. So this is a question really asking that if we add lapatinib to these patients together with their radiation, can we extend cancer control in their brain.
Women can have either whole brain radiotherapy, or SRS, and then they take 6 weeks of lapatinib. There's 3 weeks of radiation, and if it's whole brain radiation they get their lapatinib with their radiation and again 3 weeks afterward. If they're having the SRS, which can be 1 to 3 treatments, they will get their lapatinib prior to their SRS and continue it for 6 weeks.