Utidelone Plus Bevacizumab for ERBB2-Negative Metastatic Breast Cancer and Active Brain Metastases

Importance Patients with ERBB2 (formerly HER2 or HER2/neu )-negative metastatic breast cancer (MBC) and brain metastases have poor prognosis, and effective treatment options are limited. Objective To investigate the activity and safety of utidelone plus bevacizumab in patients with ERBB2 -negative MBC and active brain metastases. Design, Setting, and Participants This nonrandomized clinical trial was conducted at 5 hospitals in China. Adult patients with ERBB2 -negative MBC who had untreated or progressive brain metastases were enrolled between May 5, 2022, and October 25, 2023. The data cutoff date was May 20, 2024; data were analyzed from September 15, 2022, to July 20, 2024. Interventions Patients received bevacizumab (15 mg/kg on day 1) and utidelone (30 mg/m 2 on days 1-5) every 3 weeks until disease progression or unacceptable toxic effects. Main Outcomes and Measures The primary end point was central nervous system (CNS) objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Results A total of 47 female patients (median age, 53 years [IQR, 45-59 years]) were recruited. Of these, 35 patients had untreated brain metastases and 12 had brain metastases that had progressed after local radiotherapy. The CNS ORR was 42.6% (95% CI, 28.3%-57.8%) per RECIST version 1.1 and 40.4% (95% CI, 26.4%-55.7%) per Response Assessment in Neuro-Oncology Brain Metastases criteria. The median follow-up duration was 11.0 months (range, 2.3-23.6 months). The median progression-free survival (PFS) was 7.7 months (95% CI, 5.6-9.7), median CNS-PFS was 10.6 months (95% CI, 8.4 months to not reached), and median overall survival was 15.1 months (95% CI, 12.0 months to not reached). The most common grade 3 or higher treatment-emergent adverse events were decreased lymphocyte count in 5 patients (10.6%) and decreased white blood cell count in 3 patients (6.4%). No serious or fatal adverse events occurred. Conclusions and Relevance The findings of this nonrandomized clinical trial suggest the potential of utidelone plus bevacizumab for the treatment of patients with ERBB2 -negative MBC and active brain metastases. This treatment approach warrants further validation in a randomized clinical trial. Trial Registration ClinicalTrials.gov Identifier: NCT05357417