Nancy Lin, MD, discusses options for patients with human epidermal growth factor receptor 2-positive breast cancer who also present with brain metastases.
Nancy Lin, MD, an associate professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School, discusses options for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who also present with brain metastases.
Systemic therapies for these patients can be effective, according to Lin. She says that these systemic therpaies include a number of treatments such as neratinib (Nerlynx) plus capecitabine (Xeloda) and lapatinib (Tykerb) plus capecitabine, and tucatinib (Tukysa) plus capecitabine and trastuzumab (Herceptin). All of these therapies have demonstrated central nervous system activity. The combination of neratinib and lapatinib plus capecitabine was investigated in the phase III NALA trial, and trastuzumab was looked at in the phase II HER2CLIMB trial.
When physicians think about how to treat brain metastases in the paradigm, they don’t always have to use radiation therapy for patients with HER2-postive breast cancer and brain involvement, according to Lin. This is especially important for patients who have had prior rounds of radiation therapy because she feels it makes more sense in that situation to look at systemic approaches.