Dr. Anders on Systemic Agents for Patients With Breast Cancer and Brain Mets

Carey Anders, MD, assistant professor for the Department of Medicine, Division of Hematology and Oncology, at UNC-Chapel Hill, UNC Linebarger Comprehensive Cancer Center, discusses systemic agents available and in development for patients with breast cancer who also have brain metastases.

In terms of systemic therapy, there are methods of treating patients with triple-negative breast cancer, estrogen-receptor—positive disease, and HER2-positive disease. However, the depth of work has really involved in the HER2 subset, she explains.

Lapatinib (Tykerb) is know as the most "tried-and-true" method of treating patients with brain metastases and has been most extensively studied in HER2-positive disease. Next-generation compounds are also being explored, she adds, including ONT-380 and MM-302, which is a HER2-targeted liposomal doxorubicin. In particular, MM-302—an antibody-drug conjugate composed of a HER2-targeted antibody linked to liposomal doxorubicin—is being investigated in combination with trastuzumab in the phase II HERMIONE trial.

Patients are being randomized to MM-302 versus chemotherapy plus trastuzumab in patients with anthracycline-naïve, locally advanced, HER2-positive breast cancer who were previously treated with pertuzumab (Perjeta) and T-DM1 (ado-trastuzumab emtansine; Kadcyla).

Additionally, there are derivatives of irinotecan either as a prodrug or metabolite packed into liposomes.