the bad and the good
 

Brain metastases are prevalent in triple negative and HER2-
overexpressing (HER2+) subpopulations, and the incidence of brain
metastases approaches one-third of all metastatic HER2+ patients.
HER2+ status was found to specifically increase brain colonization
2.5-fold to 3-fold, although not affecting tumor cell arrival or intra-
vasation into the brain.

Excitingly, a study of 14C-lapatinib distribu-
tion in a 231-BR xenograft model showed a significant increase of its
distribution to the metastasis over normal brain. Indeed, lapatinib
inhibited the formati on of clinical metastases in HER2/EGFR-
expressing 231-BR cells by 54%, suggesting activity in the adjuvant
setting (2). Current work is examining rational combinations to
elicit synergistic effects with radiation and other targeted agents.

Could we ever get lapatinib cheap enough to be a preventive agent against brain mets adjuvantly?

It works on herceptin resistant Her2, blocks additional her receptors..and seems to have less cardiac issues. How long before it becomes first line, much less adjuvant?

Also, it is known that if patients have low PTEN expression (which apx 50% of breast cancers do), it can predict a resistance to trastuzamab.

Lapatinib is not affected by low PTEN expression.