Brian Czerniecki, MD, PhD, chair and senior member of the Department of Breast Oncology at Moffitt Cancer Center, discusses the benefit of tucatinib (Tukysa) in patients with HER2-positive breast cancer and brain metastases. 

 in combination with trastuzumab (Herceptin) and capecitabine (Xeloda) for the treatment of patients with unresectable locally advanced or metastatic HER2-positive breast cancer, including those patients with brain metastases, following at least 1 prior anti–HER2­-based therapy in the metastatic setting. 

The approval is based on findings from the phase 2 HER2CLIMB trial in which the triplet induced a 34% reduction in the risk of death compared with trastuzumab/capecitabine alone in the overall patient population and a 52% reduction in patients with brain metastases at baseline.

Although not all patients will benefit from tucatinib, the drug appears to reduce subclinical brain metastases, as well as prevent the development of symptomatic disease in the brain in some patients, says Czerniecki. Ultimately, the agent can have a significant impact on the treatment of about one-third of patients in this space, Czerniecki concludes.

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Brian Czerniecki, MD, PhD, discusses the benefit of tucatinib in patients with HER2-positive breast cancer and brain metastases.  




Dr. Czerniecki on the Benefit of Tucatinib in HER2+ Breast Cancer and Brain Metastases

Brian Czerniecki, MD, PhD, chair and senior member of the Department of Breast Oncology at Moffitt Cancer Center, discusses the importance of a multidisciplinary effort to treat patients with breast cancer who develop brain or central nervous system (CNS) metastases.

The treatment metastases, whether they are solid brain tumors or CNS metastases, often takes a collaboration between neurosurgery, with the possibility of the patient being resected; or if the patient is symptomatic, radiation therapy because methods are available to perform radiosurgery; and medical oncology because most of these patients have disease inside and outside of the CNS, says Czerniecki. Targeted therapies may also be beneficial in this population if they are capable of crossing the blood-brain barrier.

For many patients who have CNS disease, their blood-brain barrier becomes somewhat altered or destroyed, which allows some targeted agents and smaller chemotherapy molecules to enter the brain and have an effect, concludes Czerniecki.

Brian Czerniecki, MD, PhD, discusses the importance of utilizing a multidisciplinary effort to treat patients with breast cancer who develop brain or central nervous system metastases.

Dr. Czerniecki on the Importance of Multidisciplinary Efforts for Breast Cancer Brain/CNS Metastases

Brian Czerniecki, MD, PhD, chair and senior member, Department of Breast Oncology at Moffitt Cancer Center, discusses treatment options for patients with HER2-positive breast cancer who have brain metastases.

Local or systemic HER2-directed therapies are critical in treating patients with brain metastases, says Czerniecki.

These agents may be delivered into the brain in the central nervous system (CNS) via CNS catheters such as the MAYA balloon catheter, explains Czerniecki. The MAYA catheter, placed in the patient’s cerebrospinal fluid, can deliver higher levels of the targeted agent across the blood–brain barrier compared with systemic therapy alone.

Additionally, TKIs including tucatinib (Tukysa), neratinib (Nerlynx), and lapatinib (Tykerb) have demonstrated some utility in patients with HER2-positive disease and brain metastases, says Czerniecki.

For example, lapatinib is a smaller molecule that can cross the blood–brain barrier. Tucatinib, which was recently granted FDA approval in metastatic HER2-positive breast cancer, has demonstrated CNS activity as well, concludes Czerniecki. 

Brian Czerniecki, MD, PhD, discusses treatment options for patients with HER2-positive breast cancer who have brain metastases.



Brian Czerniecki, MD, PhD

Articles

Dr. Czerniecki on the Benefit of Tucatinib in HER2+ Breast Cancer and Brain Metastases

Dr. Czerniecki on the Importance of Multidisciplinary Efforts for Breast Cancer Brain/CNS Metastases

Dr. Czerniecki on Treatment Options for Patients With HER2+ Brain Metastases