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Neratinib Efficacy and Circulating Tumor DNA Detection of HER2 Mutations in HER2 Nonamplified Metastatic Breast Cancer
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Abstract
Purpose: Based on promising preclinical data, we conducted a single-arm phase II trial to assess the clinical benefit rate (CBR) of neratinib, defined as complete/partial response (CR/PR) or stable disease (SD) ≥24 weeks, in HER2mut nonamplified metastatic breast cancer (MBC). Secondary endpoints included progression-free survival (PFS), toxicity, and circulating tumor DNA (ctDNA) HER2mut detection. Experimental Design: Tumor tissue positive for HER2mut was required for eligibility. Neratinib was administered 240 mg daily with prophylactic loperamide. ctDNA sequencing was performed retrospectively for 54 patients (14 positive and 40 negative for tumor HER2mut). Results: Nine of 381 tumors (2.4%) sequenced centrally harbored HER2mut (lobular 7.8% vs. ductal 1.6%; P = 0.026). Thirteen additional HER2mut cases were identified locally. Twenty-one of these 22 HER2mut cases were estrogen receptor positive. Sixteen patients [median age 58 (31–74) years and three (2–10) prior metastatic regimens] received neratinib. The CBR was 31% [90% confidence interval (CI), 13%–55%], including one CR, one PR, and three SD ≥24 weeks. Median PFS was 16 (90% CI, 8–31) weeks. Diarrhea (grade 2, 44%; grade 3, 25%) was the most common adverse event. Baseline ctDNA sequencing identified the same HER2mut in 11 of 14 tumor-positive cases (sensitivity, 79%; 90% CI, 53%–94%) and correctly assigned 32 of 32 informative negative cases (specificity, 100%; 90% CI, 91%–100%). In addition, ctDNA HER2mut variant allele frequency decreased in nine of 11 paired samples at week 4, followed by an increase upon progression. Conclusions: Neratinib is active in HER2mut, nonamplified MBC. ctDNA sequencing offers a noninvasive strategy to identify patients with HER2mut cancers for clinical trial participation. Clin Cancer Res; 23(19); 5687–95. ©2017 AACR.
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“Not only does it competitively occupy the ATP-binding site on EGFR, but it also binds to the unique amino acid residue Cys805 near the opening of the pocket-a homologous cysteine residue to EGFR Cys797-to undergo alkylation or covalent bonding, thus achieving irreversible inhibition of HER2.154,155”
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Metadata
- Authors
- Ma, C. X., Bose, R., Gao, F., Freedman, R. A., Telli, M. L., Kimmick, G., Winer, E., Naughton, M., Goetz, M. P., Russell, C., Tripathy, D., Cobleigh, M., Forero, A., Pluard, T. J., Anders, C., Niravath, P. A., Thomas, S., Anderson, J., Bumb, C., Banks, K. C., Lanman, R. B., Bryce, R., Lalani, A. S., Pfeifer, J., Hayes, D. F., Pegram, M., Blackwell, K., Bedard, P. L., Al-Kateb, H., & Ellis, M. J. C.
- Affiliations
- Washington University in St. Louis (US)
- Dana-Farber Cancer Institute (US)
- Stanford Medicine (US)
- Duke University (US)
- Mayo Clinic (US)
- University of Southern California (US)
- Rush University Medical Center (US)
- University of Alabama at Birmingham (US)
- Saint Luke's Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Baylor College of Medicine (US)
- Guardant (United States) (US)
- Puma Biotechnology (United States) (US)
- University of Michigan (US)
- Princess Margaret Cancer Centre (CA)
- 15Genomic and Pathology Service, Washington University School of Medicine, St. Louis, Missouri.
- ORCID
- Ma, Cynthia X.
- Bose, Ron
- Gao, Feng
- Freedman, Rachel A.
- Telli, Melinda L.
- Kimmick, Gretchen
- Winer, Eric
- Goetz, Matthew P.
- Russell, Christy
- Tripathy, Debu
- Cobleigh, Melody
- Forero, Andres
- Pluard, Timothy J.
- Anders, Carey
- Niravath, Polly Ann
- Thomas, Shana
- Banks, Kimberly C.
- Lanman, Richard B.
- Bryce, Richard
- Lalani, Alshad S.
- Pfeifer, John
- Hayes, Daniel F.
- Pegram, Mark
- Blackwell, Kimberly
- Bedard, Philippe L.
- Ellis, Matthew J.C.
- Venue
- Clinical Cancer Research
- Published
- 2017-10-01
- Volume
- 23
- Issue
- 19
- Pages
- 5687-5695
- ISSN
- 1078-0432 (ISSN-L)
- 1557-3265
- PMC
- PMC6746403
- OpenAlex
- W2726739357
- Cited by
- 193
- References
- 49
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 6 · 2023: 29 · 2022: 28 · 2021: 33 · 2020: 29 · 2019: 28 · 2018: 20 · 2017: 3
- FWCI
- 9.64
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Cancer Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Puma Biotechnology
- National Cancer Institute (P30CA091842, P30CA016086)
- Topics
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer Genomics and Diagnostics
- Keywords
- neratinib, HER2 mutation, circulating tumor DNA, liquid biopsy, clinical benefit rate, progression-free survival, diarrhea, HER2-positive breast cancer, lobular breast cancer, estrogen receptor-positive breast cancer, patient selection for clinical trials, targeted therapy
- MeSH terms
- Circulating Tumor DNA, Adult, Aged, Breast Neoplasms, Female, Humans, Middle Aged, Mutation, Neoplasm Metastasis, Quinolines, Treatment Outcome, Disease-Free Survival, Erb-b2 Receptor Tyrosine Kinases
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