Efficacy and determinants of response to her kinase inhibition in her2-mutant metastatic breast cancer

Lillian M. Smyth, Sarina A. Piha-Paul, Helen H. Won, Alison M. Schram, Cristina Saura, Sherene Loi, Janice Lu, Geoffrey I. Shapiro, Dejan Juric, Ingrid A. Mayer, Carlos L. Arteaga, Macarena I. de la Fuente, Adam M. Brufksy, Iben Spanggaard, Morten Mau-Sørensen, Monica Arnedos, Victor Moreno, Valentina Boni, Joohyuk Sohn, Lee S. SchwartzbergXavier Gonzàlez-Farré, Andrés Cervantes, François Clement Bidard, Alexander N. Gorelick, Richard B. Lanman, Rebecca J. Nagy, Gary A. Ulaner, Sarat Chandarlapaty, Komal Jhaveri, Elena I. Gavrila, Catherine Zimel, S. Duygu Selcuklu, Myra Melcer, Aliaksandra Samoila, Yanyan Cai, Maurizio Scaltriti, Grace Mann, Feng Xu, Lisa D. Eli, Melanie Dujka, Alshad S. Lalani, Richard Bryce, José Baselga, Barry S. Taylor, David B. Solit, Funda Meric-Bernstam, David M. Hyman

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


HER2 mutations define a subset of metastatic breast cancers with a unique mechanism of oncogenic addiction to HER2 signaling. We explored activity of the irreversible pan-HER kinase inhibitor neratinib, alone or with fulvestrant, in 81 patients with HER2-mutant metastatic breast cancer. Overall response rate was similar with or without estrogen receptor (ER) blockade. By comparison, progression-free survival and duration of response appeared longer in ER+ patients receiving combination therapy, although the study was not designed for direct comparison. Preexistent concurrent activating HER2 or HER3 alterations were associated with poor treatment outcome. Similarly, acquisition of multiple HER2-activating events, as well as gatekeeper alterations, were observed at disease progression in a high proportion of patients deriving clinical benefit from neratinib. Collectively, these data define HER2 mutations as a therapeutic target in breast cancer and suggest that coexistence of additional HER signaling alterations may promote both de novo and acquired resistance to neratinib. SIGNIFICANCE: HER2 mutations define a targetable breast cancer subset, although sensitivity to irreversible HER kinase inhibition appears to be modified by the presence of concurrent activating genomic events in the pathway. These findings have implications for potential future combinatorial approaches and broader therapeutic development for this genomically defined subset of breast cancer.

Original languageEnglish (US)
Pages (from-to)198-213
Number of pages16
JournalCancer discovery
Issue number2
StatePublished - Feb 2020

ASJC Scopus subject areas

  • Oncology


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