Efficacy and Determinants of Response to HER Kinase Inhibition in -Mutant Metastatic Breast Cancer

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 -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 or alterations were associated with poor treatment outcome. Similarly, acquisition of multiple -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 mutations as a therapeutic target in breast cancer and suggest that coexistence of additional HER signaling alterations may promote both and acquired resistance to neratinib. SIGNIFICANCE: 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..