Healthcare Industry News: HER2
News Release - December 17, 2007
GlaxoSmithKline Announces Data on TYKERB(R) (Lapatinib) Plus Capecitabine for the Treatment of HER2 Positive Breast Cancer Brain MetastasesStudy Shows TYKERB Combination Reduced the Size of Brain Tumors Associated with HER2-Positive Breast Cancer
SAN ANTONIO, Texas, Dec. 17 (HSMN NewsFeed) -- GlaxoSmithKline announced today results from the extension arm of a Phase II study on its first-in-class, oral small molecule HER2 (ErbB2) kinase inhibitor, TYKERB® (lapatinib). In this study of 49 patients, the combination of TYKERB plus capecitabine (Xeloda®) showed a reduction in HER2-positive breast cancer that had spread to the brain and had progressed on TYKERB alone(1). Specifically, 20 percent of patients who received TYKERB plus capecitabine experienced at least a 50 percent volumetric reduction in measurable brain metastases; 37 percent of patients experienced a volumetric decrease that was greater than or equal to 20 percent. This is important because up to one-third of women with HER2-positive metastatic breast cancer may develop brain metastases during the course of their disease(2). Results of this and other important TYKERB studies are being presented at the 2007 San Antonio Breast Cancer Symposium in San Antonio, TX.
"As women live longer with advanced breast cancer, some are developing brain metastases that are getting worse despite standard treatments, such as radiation," said Nancy U. Lin, M.D., lead investigator and Instructor in Medicine, Dana-Farber Cancer Institute. "Very few medications have shown activity in the treatment of brain metastases, in particular HER2-positive metastatic breast cancer patients and therefore, these data are quite encouraging."
TYKERB, in combination with capecitabine, is approved in the United States for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2 and who have received prior therapy including an anthracycline, a taxane and trastuzumab (Herceptin®)(3). Additional studies are underway to learn the full potential of TYKERB for the prevention and treatment of brain metastases.
"I know first hand that HER2-positive breast cancer can have unique, difficult-to-treat complications. Brain metastases can be particularly devastating for patients, as they may cause blurred vision, speech impairments and can limit patients' ability to engage in even simple day-to-day activities," said Christine Druther, MSPH, founder and president, HER2 Support Group. "We look forward to the results of any and all research in the treatment of HER2-positive breast cancer and its complications."
Data Presented on Abstract 6076(1)
In this study, the combination of TYKERB plus capecitabine showed a reduction in HER2-positive breast cancer that had spread to the brain and had progressed on TYKERB alone. Preliminary results are available from the initial 49 patients who enrolled in the TYKERB plus capecitabine extension arm as of March 2007. Exploratory analysis revealed 18 patients (37 percent) experienced at least a 20 percent volume reduction in brain metastases, without progression of their disease outside of the brain, increase in steroid requirements or worsening of neurological signs or symptoms, and a median reduction in brain metastases of 4.8 cm(3). Of these 18 patients, 10 patients (20 percent) experienced at least a 50 percent volume reduction in brain metastases with a median reduction in brain metastases of 7.1 cm(3). As of September 2007, three patients remained on the parent study with TYKERB monotherapy and of the 51 patients enrolled in the extension arm with TYKERB plus capecitabine, eight remained on lapatinib plus capecitabine.
Of the 51 patients enrolled in the extension arm, 10 (20 percent) who received TYKERB plus capecitabine experienced a partial response and 20 patients (39 percent) achieved stable disease. The disease progressed in fifteen patients (29 percent) who received the combination. The status of 6 patients (12%) was unknown at the time of reporting.
The most commonly reported Grade 1/2 adverse events include hand-foot syndrome (palmar-plantar eryrthrodysaesthesia) (37 percent), diarrhea (34 percent), nausea (22 percent), vomiting (12 percent), anorexia (12 percent), and nail disorder (12 percent). The most common Grade 3 adverse events include hand-foot syndrome (8 percent), nausea (8 percent), vomiting (6 percent), diarrhea (4 percent) and fatigue (2 percent).
"This trial and the ongoing clinical development program for TYKERB represent GSK Oncology's commitment to developing treatments that help improve the lives of cancer patients," said Paolo Paoletti, M.D., Senior Vice President of the Oncology Medicine Development Center at GSK. "We plan to further study the effects of TYKERB in HER2-positive patients with brain metastases."
Brain Metastases Associated with HER2-Positive Breast Cancer
Metastatic breast cancer is the second most common type of cancer to develop brain metastases(4). Approximately 10 percent of newly diagnosed breast cancer patients have locally advanced and/or metastatic disease; 20 to 85 percent of patients (depending on initial stage, tumor biology, and treatment strategy) diagnosed with early breast cancer will develop recurrent and/or metastatic disease(5). Up to one-third of women with HER2-positive breast cancer may develop brain metastases(2).
TYKERB/TYVERB (lapatinib) is a first-in-class oral small-molecule inhibitor of the HER2 (ErbB2) tyrosine kinase receptor. Stimulation of HER2 is associated with cell proliferation and with multiple processes involved in tumor progression and metastases. Overexpression of this receptor has been reported in a variety of human tumors and is associated with poor prognosis and reduced overall survival. On March 13, 2007, the United States Food and Drug Administration (FDA) approved TYKERB, in combination with capecitabine, for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2 and who have received prior therapy including an anthracycline, a taxane, and trastuzumab.
TYVERB has been approved in more than 15 countries, and marketing applications for TYKERB/TYVERB have been filed around the world.
Important Safety Information*
As with other therapies for HER2 overexpression, Tykerb has been associated with reports of decreases in left ventricular ejection fraction (LVEF). Caution should be taken if Tykerb is to be administered to patients with pre-existing cardiac conditions, including uncontrolled or symptomatic angina, arrhythmias, or congestive heart failure. LVEF should be evaluated in all patients prior to and during treatment with Tykerb.
A dose reduction should be considered for patients with severe hepatic impairment.
Diarrhea was the most common adverse event resulting in discontinuation of study medication. Proactive management of diarrhea with anti-diarrheal agents is important, and severe cases of diarrhea may require administration of oral or intravenous electrolytes and fluids and interruption or discontinuation of therapy with Tykerb.
Tykerb has been associated with interstitial lung disease and pneumonitis. Discontinue Tykerb if patients experience severe pulmonary symptoms.*
Tykerb prolongs the QT interval in some patients. Consider ECG and electrolyte monitoring.
Fetal harm can occur when administered to a pregnant woman. Women should be advised not to become pregnant when taking Tykerb.
The most common adverse events (>20 percent) during treatment with Tykerb plus capecitabine were diarrhea, vomiting, nausea, fatigue, palmar-plantar erythrodysethesia, and rash.
*Please see full prescribing information.
GlaxoSmithKline -- one of the world's leading research-based pharmaceutical and healthcare companies -- is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For company information, visit GlaxoSmithKline at www.gsk.com.
Cautionary statement regarding forward-looking statements
Under the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995, the company cautions investors that any forward-looking statements or projections made by the company, including those made in this Announcement, are subject to risks and uncertainties that may cause actual results to differ materially from those projected. Factors that may affect the Group's operations are described under 'Risk Factors' in the 'Business Review' in the company's Annual Report on Form 20-F for 2006.
Note to Editors
TYKERB® is a registered trademark of the GlaxoSmithKline group of companies in the United States.
TYVERB® is a registered trademark of the GlaxoSmithKline group of companies in Europe and is the proposed trade name in certain markets, pending regulatory approval.
Herceptin® is a registered trademark of Genentech, Inc. in the U.S. and Roche Pharmaceuticals in Europe.
Xeloda® is a registered trademark of Roche Pharmaceuticals.
1. Lin, N.U., Lapatinib and capecitabine for the treatment of brain metastases in patients with HER2+ breast cancer -- an updated analysis from EGF105084., Presented at the 2007 San Antonio Breast Cancer Symposium, San Antonio, TX, December 16, 2007.
2. Bendell JC, et al. Central Nervous System Metastases in Women who Receive Trastuzumab-Based Therapy for Metastatic Breast Carcinoma. Cancer 2003; 97: 2972-2977.
3. TYKERB Prescribing Information, 2007.
4. American Brain Tumor Association, Metastatic Brain Tumors. Available at http://hope.abta.org/site/DocServer/Metastatic.pdf?docID=221. Accessed on April 9, 2007.
5. C. Bernard-Marty et al. Facts and Controversies in Treatment of Systemic Metastatic Breast Cancer. The Oncologist. 2004:9:617-632.
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