Kamran A. Ahmed, MD, an assistant member in the Department of Radiation Oncology and the Department of Immunology at Moffitt Cancer Center, and an assistant professor in the Department of Oncologic Sciences at the University of South Florida, discusses the need for multidisciplinary care in patients with HER2-positive breast cancer and leptomeningeal disease.

Leptomeningeal disease poses significant challenges for patients with HER2-positive breast cancer in terms of disease management, says Ahmed. As such, patients require a multidisciplinary approach to treatment, Ahmed explains.

Often, these patients have poor prognoses and require management of their intracranial, as well as extracranial disease, Ahmed says. Therefore, patients should be under the care of medical oncologists, neuro-oncologists, and radiation oncologists, among others, explains Ahmed.

Notably, during the 2021 ASCO Annual Meeting, the study schema of an ongoing phase 1/2 trial (NCT04588545) evaluating a multidisciplinary treatment approach with radiation therapy followed by intrathecal trastuzumab (Herceptin) plus pertuzumab (Perjeta) was presented as an investigational option for patients with HER2-positive breast cancer and leptomeningeal disease, concludes Ahmed.

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Kamran A. Ahmed, MD, discusses the need for multidisciplinary care in patients with HER2-positive breast cancer and leptomeningeal disease.  



Dr. Ahmed on the Need for Multidisciplinary Care in HER2+ Breast Leptomeningeal Disease 

Kamran A. Ahmed, MD, an assistant member in the Department of Radiation Oncology and the Department of Immunology at Moffitt Cancer Center, and an assistant professor in the Department of Oncologic Sciences at the University of South Florida, discusses the impact of neratinib (Nerlynx) on patients with central nervous system (CNS) metastases and HER2-positive breast cancer.

The phase 3 NALA trial demonstrated a 24% reduction in the risk of disease progression or death with the combination of neratinib and capecitabine (Xeloda) compared with lapatinib (Tykerb) plus capecitabine in patients with advanced or metastatic HER2-positive breast cancer who had received 2 or more prior anti­­–HER2-based regimens in the metastatic setting.

Moreover, at 54 months, the cumulative incidence for intervention for CNS metastases was 22.8% versus 29.2% for neratinib and lapatinib, respectively, explains Ahmed. 

Regarding safety, neratinib was associated with a greater incidence of grade 3 diarrhea compared with lapatinib, at 24% and 13%, respectively, Ahmed says. 

Ultimately, these findings served as the basis for the FDA approval of neratinib plus capecitabine in this patient population, concludes Ahmed. 

Kamran A. Ahmed, MD, discusses the impact of neratinib on patients with central nervous system metastases and HER2-positive breast cancer.  



Dr. Ahmed on the Impact of Neratinib on CNS Metastases in HER2+ Breast Cancer 

Kamran A. Ahmed, MD, an assistant member in the Department of Radiation Oncology and the Department of Immunology at Moffitt Cancer Center and an assistant professor in the Department of Oncologic Sciences at the University of South Florida, discusses the role of multidisciplinary care in breast cancer–related brain metastases.

Data from the phase 2 HER2CLIMB and phase 3 NALA trials, as well as targeted therapies in the pipeline, have demonstrated a role for systemic therapy in the management of patients with breast cancer–related brain metastases, says Ahmed.

As such, managing these patients through a multidisciplinary care team is critical, Ahmed explains. Radiation oncologists and neurosurgeons should elicit the input of medical oncologists who may be guiding central nervous system–directed systemic care.

Additionally, as data remain limited in this space, enrolling patients on clinical trials remains a valuable option in improving therapies and identifying new options for this patient population, concludes Ahmed.

Kamran A. Ahmed, MD, discusses the role of multidisciplinary care in breast cancer–related brain metastases.  



Dr. Ahmed on the Role of Multidisciplinary Care in Breast Cancer Brain Metastases 

Kamran A. Ahmed, MD, an assistant member in the Department of Radiation Oncology and the Department of Immunology at Moffitt Cancer Center and an assistant professor in the Department of Oncologic Sciences at the University of South Florida, discusses remaining questions with the use of tucatinib (Tukysa) in breast cancer–related brain metastases.

demonstrated that tucatinib has a role in metastatic breast cancer, says Ahmed. What is interesting to see from the central nervous system data presented during the 

 is the potential role that systemic therapies, such as tucatinib, have in the management of patients with active brain metastases who have not received previous local therapy.

However, questions remain with regard to the agent’s potential role in the management of patients with small asymptomatic brain metastases. In order to examine the intracranial response rate data in greater detail, the full study will need to be released; however, the available data reported thus far is quite intriguing, concludes Ahmed.

Kamran A. Ahmed, MD, discusses remaining questions with the use of tucatinib in breast cancer–related brain metastases.

Dr. Ahmed on Remaining Questions With Tucatinib in Breast Cancer Brain Metastases

Kamran A. Ahmed, MD, an assistant member in the Department of Radiation Oncology and the Department of Immunology at Moffitt Cancer Center, and an assistant professor in the Department of Oncologic Sciences at the University of South Florida, discusses key strategies to manage patients with breast cancer and brain metastases.

The primary strategy that is in place for the majority of patients with breast cancer that has spread to the brain is local therapies, says Ahmed. The cornerstone is still radiation therapy and potentially surgery. Additionally, several agents in the breast cancer space have been shown to result in good outcomes, as well as the potential to improve intracranial progression. Specifically in the HER2-positive space, data have come out on HER2-specific TKIs in addition to other targeted agents.

Additionally, other agents are also under investigation in the hormone receptor–positive, HER2-negative, and triple-negative breast cancer space that will hopefully show positive outcomes in the future, concludes Ahmed.

Kamran A. Ahmed, MD, discusses key strategies to manage patients with breast cancer and brain metastases.

Kamran A. Ahmed, MD

Articles

Dr. Ahmed on the Need for Multidisciplinary Care in HER2+ Breast Leptomeningeal Disease

Dr. Ahmed on the Impact of Neratinib on CNS Metastases in HER2+ Breast Cancer

Dr. Ahmed on the Role of Multidisciplinary Care in Breast Cancer Brain Metastases

Dr. Ahmed on Remaining Questions With Tucatinib in Breast Cancer Brain Metastases

Dr. Ahmed on Key Strategies for Managing Breast Cancer Brain Metastases