Novel HER-2 Targeted Agents Show Promise in Treating CNS Metastases


A recent study looking at data from three clinical trials involving Nerlynx shows promise for the future of treating patients with HER-2 positive breast cancer who develop CNS metastases.

HER-2 targeted tyrosine kinase inhibitors (TKI), such as Nerlynx (neratinib), are proving beneficial in patients who develop central nervous system (CNS) metastases with HER-2 positive metastatic breast cancer and could act as a viable treatment to combat CNS, according to Dr. Nancy Lin.

Lin, director of the Metastatic Breast Cancer Program at Dana-Farber Cancer Institute, discussed the results of a study looking at the impact of Nerlynx on the development and progression of patients with CNS metastases by collecting and analyzing the results of three different studies.

These studies included the NALA trial, a randomized phase 3 trial comparing Nerlynx with other TKIs, NEfERT-T, a first-line trial looking at similar data, and the TBCRC 022 trials that was the only trial to look at patients with HER-2 positive metastatic breast cancer who had CNS metastases.

Lin presented data at the 2019 San Antonio Breast Cancer Symposium, where researchers found an overall response rate of 49% in patients from the TBCRC 022 trial who responded to a TKI plus chemotherapy. At the conference, Lin also had the chance to sit down with OncLive®, a sister publication to CURE®, and discuss the importance of the study and what it means for the use of Nerlynx in this patient population.


So I think that they further solidify the idea that neratinib and capecitabine do have CNS activity in patients with HER-2 positive breast cancer. I think that one important message is that CNS prevention is potentially a possible goal, and I think in a larger sense, trying to prevent CNS metastasis is a really important goal for the breast cancer community and obviously, for our patients.

I think that the key takeaway is that systemic therapy for patients with HER-2 positive breast cancer brain metastases can be effective. And this is not limited to just neratinib and capecitabine, and that there are a number of other agents, including tucatinib, including lapatinib and hopefully others in the future, that have CNS activity.

And so that when we think about the paradigm of how we treat patients with brain metastases, we don't always have to reach for radiation therapy first, especially in those patients who've had multiple prior rounds of radiation therapy, where I really think it makes a lot of sense to think about systemic approaches.

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