HER2-positive Breast Cancer with Brain Metastases? Use Lapitinibi (Tykerb) and Capecitibine (Xeloda) but NOT Trastuzumab (Herceptin)

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Human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC) is a disease that accounts for up to one third of all invasive breast tumors. The natural history of this disease, however, has been dramatically improved with the introduction of trastuzumab (Herceptin).

Despite its positive effect on overall prognosis, one third of patients treated with trastuzumab still develop brain metastases (BM). This phenomenon is due to the limited penetration ability of trastuzumab through the blood brain barrier, making the brain a sanctuary site for the development of metastases.

Lapatinib is a small molecule that has dual HER1/HER2 inhibition ability. Two previous phase II studies have demonstrated the activity of lapatinib monotherapy in breast cancer patients with brain metastases.

Now, a new study published in the Annals of Oncology further confirmed the effectiveness of lapatinib in patients with HER2-positive breast cancer and BM.

In this study, 30 HER2+ metastatic breast cancer patients treated with lapitinib and capecitibine (LC) were analyzed. All patients were previous treated with trastuzumab for metastatic disease.

Among the patients treated with LC, 7 patients (31.8%) have partial responses and 6 patients (27.3%) have stabilized disease. Patients treated with LC had a median overall survival which was significantly longer than patients treated with trastuzumab-based therapies only (27.9 months versus 16.7 months, respectively, P =0.01)

The study that indicated that lapitinib and capecitibine improved survival in breast cancer patients with brain metastases.

Source: Annals of Oncology Aug 18, 2010.

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