15 Participants Needed

Kadcyla + Neratinib for Breast Cancer

DC
Overseen ByDavid Cescon, MD PhD
Age: 18+
Sex: Any
Trial Phase: Phase 2
Sponsor: University Health Network, Toronto
Must be taking: T-DM1
Stay on Your Current MedsYou can continue your current medications while participating
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 2 JurisdictionsThis treatment is already approved in other countries

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial is for patients with early-stage HER2+ breast cancer who still have small amounts of cancer after initial treatments. They will take a drug called neratinib along with their usual treatment. Neratinib works by blocking signals that help cancer cells grow. The study aims to see if this combination improves patient outcomes.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must not have taken neratinib or other HER2 tyrosine kinase inhibitors before, and there is a 14-day period without radiation therapy required before starting the trial.

Is the combination of Kadcyla and Neratinib safe for humans?

Neratinib, also known as Nerlynx, has been shown to have an acceptable safety profile in patients with HER2-positive breast cancer and other solid tumors. The most common side effect is diarrhea, which can be managed with medication and dose adjustments. Other side effects include nausea, abdominal pain, fatigue, and rash, but these are generally manageable and reversible.12345

How does the drug Kadcyla + Neratinib differ from other breast cancer treatments?

Kadcyla + Neratinib is unique because it combines two drugs: Kadcyla, which delivers chemotherapy directly to cancer cells, and Neratinib, an oral drug that blocks specific proteins (HER1, HER2, and HER4) involved in cancer growth. This combination targets HER2-positive breast cancer more effectively by using different mechanisms to attack the cancer cells.12678

What data supports the effectiveness of the drug Neratinib (Nerlynx) for breast cancer?

Neratinib has been shown to significantly reduce the risk of breast cancer returning in patients with early-stage HER2-positive breast cancer, especially when started within a year of completing previous treatment. It has also demonstrated benefits in patients with advanced HER2-positive breast cancer when used in combination with other drugs.1291011

Are You a Good Fit for This Trial?

This trial is for adults over 18 with HER2+ stage I-III breast cancer, who've had surgery and are on T-DM1 therapy but still show signs of cancer at a molecular level. They should be in good health otherwise, able to follow the study plan, and willing to use effective birth control.

Inclusion Criteria

I am willing and able to follow the study's treatment plan and attend all visits.
I have no known allergies or adverse reactions to T-DM1 or neratinib.
I had radiation therapy but it ended at least 14 days ago.
See 10 more

Exclusion Criteria

My cancer has spread to other parts of my body.
I have HIV that is not being treated with medication.
I have or had hepatitis B or C, but it's not active now.
See 5 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive standard T-DM1 adjuvant therapy with Neratinib for up to 12 months

12 months
Every 3 weeks for T-DM1 infusion

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months

What Are the Treatments Tested in This Trial?

Interventions

  • Neratinib
Trial Overview The trial tests if adding neratinib (a pill taken daily) to standard T-DM1 therapy can clear remaining cancer traces after initial treatment. It's given for up to a year unless there's recurrence or side effects leading to stopping the drug.
How Is the Trial Designed?
1Treatment groups
Experimental Treatment
Group I: Neratinib ArmExperimental Treatment1 Intervention
Standard T-DM1 (3.6mg/kg) IV infusion every 3 weeks administered with Neratinib (160 mg) orally once daily up to 1 year.

Find a Clinic Near You

Who Is Running the Clinical Trial?

University Health Network, Toronto

Lead Sponsor

Trials
1,555
Recruited
526,000+

Published Research Related to This Trial

In a study of 72 patients with advanced HER2-positive breast cancer, neratinib, either alone or combined with capecitabine, demonstrated a median progression-free survival (PFS) of 5.9 months and an overall survival (OS) of 15.0 months, indicating its efficacy in a real-world setting.
Diarrhea was the most common side effect, affecting 64% of patients, but with proper anti-diarrheal prophylaxis, the treatment was generally well-tolerated, allowing for safe administration without severe toxicities.
Neratinib in advanced HER2-positive breast cancer: experience from the royal Marsden hospital.Cunningham, N., Shepherd, S., Mohammed, K., et al.[2022]
In a phase I study involving 21 women with HER2-positive metastatic breast cancer, the combination of neratinib, trastuzumab, and paclitaxel showed significant clinical benefits, with 38% of patients achieving objective responses and 52% experiencing clinical benefit lasting at least 24 weeks.
The recommended dose of neratinib was found to be 200 mg/day, and while common side effects included diarrhea and fatigue, the implementation of prophylactic measures effectively managed severe diarrhea, indicating a favorable safety profile for this combination therapy.
Safety and efficacy of neratinib in combination with weekly paclitaxel and trastuzumab in women with metastatic HER2‑positive breast cancer: an NSABP Foundation Research Program phase I study.Jankowitz, RC., Abraham, J., Tan, AR., et al.[2019]
In a phase III trial involving 621 patients with HER2-positive metastatic breast cancer, the combination of neratinib and capecitabine (N+C) showed significant improvement in progression-free survival (PFS) compared to lapatinib and capecitabine (L+C).
Higher levels of HER2 protein expression were linked to longer PFS and greater benefits from N+C treatment, while PIK3CA mutations were associated with shorter PFS, indicating that biomarker status can influence treatment outcomes.
Biomarker Analysis of the Phase III NALA Study of Neratinib + Capecitabine versus Lapatinib + Capecitabine in Patients with Previously Treated Metastatic Breast Cancer.Saura, C., Matito, J., Oliveira, M., et al.[2023]

Citations

Neratinib in advanced HER2-positive breast cancer: experience from the royal Marsden hospital. [2022]
Safety and efficacy of neratinib in combination with weekly paclitaxel and trastuzumab in women with metastatic HER2‑positive breast cancer: an NSABP Foundation Research Program phase I study. [2019]
Biomarker Analysis of the Phase III NALA Study of Neratinib + Capecitabine versus Lapatinib + Capecitabine in Patients with Previously Treated Metastatic Breast Cancer. [2023]
Neratinib in Early-Stage Breast Cancer: A Profile of Its Use in the EU. [2021]
Neratinib: First Global Approval. [2019]
Combination neratinib (HKI-272) and paclitaxel therapy in patients with HER2-positive metastatic breast cancer. [2023]
U.S. Food and Drug Administration Approval: Neratinib for the Extended Adjuvant Treatment of Early-Stage HER2-Positive Breast Cancer. [2019]
Safety and Efficacy Profile of Neratinib: A Systematic Review and Meta-Analysis of 23 Prospective Clinical Trials. [2021]
Safety, efficacy and pharmacokinetics of neratinib (HKI-272) in Japanese patients with advanced solid tumors: a Phase 1 dose-escalation study. [2022]
10.United Statespubmed.ncbi.nlm.nih.gov
Combining Neratinib with CDK4/6, mTOR, and MEK Inhibitors in Models of HER2-positive Cancer. [2022]
Safety and efficacy of neratinib (HKI-272) plus vinorelbine in the treatment of patients with ErbB2-positive metastatic breast cancer pretreated with anti-HER2 therapy. [2020]
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