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Randomized phase II study of lapatinib plus capecitabine or lapatinib plus topotecan for patients with HER2-positive breast cancer brain metastases

  • Clinical Study – Patient Study
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Abstract

Approximately one-third of patients with advanced, HER2-positive breast cancer develop brain metastases. A significant proportion of women experience central nervous system (CNS) progression after standard radiation therapy. The optimal treatment in the refractory setting is undefined. This study evaluated the toxicity and efficacy of lapatinib in combination with chemotherapy among patients with HER2-positive, progressive brain metastases. Patients with HER2-positive breast cancer with progressive brain metastases after trastuzumab and cranial radiotherapy were included. The primary endpoint was CNS objective response, defined as a ≥50% volumetric reduction of CNS lesion(s) in the absence of new or progressive CNS or non-CNS lesions, or increasing steroid requirements. The study was closed early after 22 of a planned 110 patients were enrolled due to excess toxicity and lack of efficacy in the lapatinib plus topotecan arm. The objective response rate (ORR) in the lapatinib plus capecitabine arm was 38% (exact 95% confidence interval [CI] 13.9–68.4). No responses were observed in the lapatinib plus topotecan arm. Although the study was stopped prior to full enrollment, some promising indications of CNS activity were noted for lapatinib plus capecitabine. The combination of lapatinib plus topotecan was not active and was associated with excess toxicity.

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Acknowledgments

The authors would like to acknowledge the work of Trinity Urban and Gordon J. Harris, M.D. (Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center) for independent radiology review including volumetric analyses of brain MRIs. The authors would also like to acknowledge the following investigators and study sites for their contributions to the study: Steve Chui, Oregon Health and Science University, Portland, OR; Catherine Doyle, Hopital du Saint Sacrement du CHAUQ-Quebec-Canada; Gabrielle Doering, Praxis fuer Haematologie und Onkologie, Bremen, Germany; Ella Evron, Assaf Harofeh MC, Zrifin, Israel; Karen Gelmon, BC Cancer Agency, Vancouver Centre, Vancouver, Canada; Henrik Lindman, Akademiska Sjukhuset, Uppsala, Sweden; Minetta Liu, Georgetown University Hospital, Washington, D.C.; Rafael Lopez, Clinico de Santiago—Santiago de Compostela-Spain; Franco Nole, Instituto Europeo di Oncologia (IRCCS) di Milano, Milan, Italy; Anna Maria Storniolo, Indiana University, Indianapolis, IN. The study was supported by the Breast Cancer Research Foundation (to E.P.W. and N.U.L.), American Society of Clinical Oncology Cancer Foundation (Career Development Award to N.U.L.), and GlaxoSmithKline.

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Authors and Affiliations

  1. Division of Women’s Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Nancy U. Lin & Eric P. Winer

  2. Frauen Klinik Vom Roten Kreuz, Munich, Germany

    Wolfgang Eierman

  3. IIIrd Medical Department with Hematology and Medical Oncology, Private Medical University Hospital, Salzburg, Austria

    Richard Greil

  4. Centre Rene Gauducheau, Saint-Herblain, France

    Mario Campone

  5. Sheba Medical Center, Tel Hasomer, Israel

    Bella Kaufman

  6. GlaxoSmithKline, Collegeville, PA, USA

    Klaudia Steplewski, Stephen R. Lane, Denise Zembryki & Stephen D. Rubin

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  1. Nancy U. Lin
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  2. Wolfgang Eierman
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  3. Richard Greil
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  4. Mario Campone
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  5. Bella Kaufman
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  6. Klaudia Steplewski
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  7. Stephen R. Lane
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  9. Stephen D. Rubin
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  10. Eric P. Winer
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Correspondence to Nancy U. Lin.

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Lin, N.U., Eierman, W., Greil, R. et al. Randomized phase II study of lapatinib plus capecitabine or lapatinib plus topotecan for patients with HER2-positive breast cancer brain metastases. J Neurooncol 105, 613–620 (2011). https://doi.org/10.1007/s11060-011-0629-y

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  • DOI: https://doi.org/10.1007/s11060-011-0629-y

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