Small molecule inhibitor shows promise in trastuzumab-resistant metastatic breast can

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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

Abstract

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/m² 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/m² vinorelbine, so the dose was escalated to 240 mg neratinib- 25 mg/m² 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/m² 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.