ournal of Clinical Oncology, 2009 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 27, No 15S (May 20 Supplement), 2009: e14554
© 2009
American Society of Clinical Oncology
Safety and efficacy of neratinib (HKI-272) in combination with vinorelbine in patients with solid tumors
S. A. Limentani, A. Awada, L. Dirix, J. Beck, V. Dieras, F. Binlich, C. Germa, V. Agrapart, C. Powell and D. Hershman Carolinas Hematology Oncology Associates, Charlotte, NC; Institut Jules Bordet Unite du Chimiotherapie, Brussels, Belgium; Medische Oncologie, Wilrijk, Belgium; Highlands Oncology Group, Fayetteville, AR; Institut Curie, Unite D’Investigation Clinique, Paris, France; Wyeth Research, Paris, France; Wyeth Research, Cambridge, MA; Columbia Presbyterian Hospital, New York, NY
e14554
Background: Neratinib (HKI-272) is a potent irreversible pan-ErbB
tyrosine kinase inhibitor. Preclinical studies have shown synergistic
antitumor activity with the combination of trastuzumab plus
vinorelbine in metastatic breast cancer.The recommended dose
of neratinib in monotherapy is 240 mg. In this phase 1 study,
a combination dose of neratinib plus vinorelbine that is tolerable
was determined in patients (pts) with solid tumors.
Methods: This is an open-label, 2-part study of ascending multiple daily
oral doses of neratinib (160 mg, 240 mg) in combination with
25 mg/m
2 IV vinorelbine (administered on days 1, 8 every 3 wks).
Tumor measurements were made every 6 wks by modified RECIST
criteria.
Results: 6 pts have been treated at each dose level.
Data for 12 pts (5 pts still ongoing) as of 30 Oct 2008 are
presented (median age [range] of 53.5 [38–75] yrs; 83%
female). The median duration of treatment [range] was 1.9 [1.5–2.7]
m. There was only 1 dose limiting toxicity (DLT) of grade 3
neuropathy (pt had preexisting grade 1 neuropathy) at 160 mg
neratinib-25 mg/m
2 vinorelbine, so the dose was escalated to
240 mg neratinib- 25 mg/m
2 vinorelbine. In this cohort, there
were no DLTs, and since the neratinib and vinorelbine doses
reached full standard doses there was no need for further dose
escalation. AEs, any causality, all grades in
15% of pts included
diarrhea (92%), nausea (67%), constipation (50%), fatigue (42%),
vomiting and anthralgia (33% each), abdominal pain and anorexia,
(25% each), anemia and neutropenia (17% each). Grade
3 AEs that
occurred in
1 pt included neutropenia (2 pts), pneumonia (1
pt) and peripheral neuropathy (2 pts). Preliminary efficacy
data show that 1 pt with stomach cancer had stable disease,
lasting
21 weeks.
Conclusions: The combination of 240 mg neratinib
and 25 mg/m
2 vinorelbine was found to be tolerable and to demonstrate
early evidence of clinical benefit in pts with solid tumors,
to be assessed further in pts with metastatic ErbB-2+ breast
cancer in part 2.