Dr. Anders Discusses the Use of Neratinib/Capecitabine for HER2-Positive Brain Metastases

Carey Anders, MD, medical director, Brain and Spine Metastasis Program, Duke Cancer Institute, discusses the use of neratinib (Nerlynx) and capecitabine in patients with HER2-positive breast cancer that has metastasized to the brain.

At the 2019 ASCO Annual Meeting, results from the phase III NALA trial were presented. In the trial, patients with or without brain metastases were randomized to receive the combination of the irreversible pan-HER TKI neratinib plus capecitabine or the reversible TKI, lapatinib (Tykerb) plus capecitabine. Results demonstrated an improvement in progression-free survival with the neratinib combination in all-comers. Notably, in patients with brain metastases, the time to intervention was delayed with neratinib.

Based on these results, and in the absence of a contraindication, patients with HER2-positive brain metastases should receive the combination of neratinib and capecitabine as opposed to the combination of lapatinib and capecitabine, says Anders. If patients start on the combination of neratinib and capecitabine, they should also receive antidiarrheal prophylaxis, particularly within the first 2 cycles of treatment with neratinib, she concludes.