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Published on: June 26, 2019
Afatinib in the treatment of breast cancer
Sara A Hurvitz1, Rebecca Shatsky, Nadia Harbeck
1University of California, Division of Hematology-Oncology, Department of Medicine , 10945 Le Conte Avenue, PVUB Suite 3360, Los Angeles, CA 90095 , USA +1 310 829 5471 ; +1 310 829 6192 ; shurvitz@mednet.ucla.edu.
Introduction:
Trastuzumab has dramatically improved outcomes for those diagnosed with human EGFR2 (HER2)-positive breast cancer. Resistance to trastuzumab, however, is an ongoing problem that has led to the development of a number of new HER2-targeted therapies. Afatinib is a novel, orally bioavailable irreversible pan-HER inhibitor that has been evaluated in multiple tumor types. It has also shown promise in NSCLC where it has earned FDA approval. Its activity in breast cancer is currently being evaluated.
Areas Covered:
This review briefly summarizes the current therapies available for HER2-positive metastatic disease. This article also describes the data available for afatinib in breast cancer from preclinical analyses, published Phase I and II trials to ongoing and upcoming Phase II and III studies.
Expert Opinion:
While Phase I and II studies have demonstrated promising activity in HER2-positive breast cancer, the Phase III randomized study of afatinib in trastuzumab-resistant metastatic breast cancer was halted early due to unfavorable risk-benefit analysis from the Independent Data Monitoring Committee (IDMC). The successful development of afatinib in breast cancer will thus depend on aggressively preventing and managing its associated toxicities.
Insights
Afatinib shows promise for HER2-positive breast cancer, but a Phase III trial was halted due to safety concerns. Managing afatinib
Area of Science:
- Oncology
- Pharmacology
Background:
- Trastuzumab has improved outcomes for HER2-positive breast cancer.
- Resistance to trastuzumab necessitates new HER2-targeted therapies.
- Afatinib is an irreversible pan-HER inhibitor with FDA approval in NSCLC.
Purpose of the Study:
- To review current therapies for HER2-positive metastatic breast cancer.
- To summarize afatinib's data in breast cancer from preclinical to Phase III studies.
Main Methods:
- Literature review of preclinical analyses, Phase I, II, and III trials.
- Summary of afatinib's efficacy and safety in HER2-positive breast cancer.
Main Results:
- Phase I and II studies indicated promising activity for afatinib.
- A Phase III trial in trastuzumab-resistant metastatic breast cancer was terminated early.
- The early termination was due to an unfavorable risk-benefit analysis.
Conclusions:
- Afatinib demonstrated promising activity in early-phase HER2-positive breast cancer trials.
- The Phase III trial's early halt highlights significant toxicity concerns.
- Future development of afatinib in breast cancer hinges on effective toxicity management.
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