The Efficacy and Safety of Inetetamab and Pyrotinib in Combination with Vinorelbine for Second-line Therapy and Beyond in HER2-positive Metastatic Breast Cancer: A Single-institution Clinical Experience

Background and Objective: This study aimed to observe the efficacy and safety of inetetamab and pyrotinib in combination with vinorelbine in second-line therapy and beyond in HER2-positive metastatic breast cancer (MBC). background: Although antibody-drug conjugate (ADC) drugs are the standard second-line therapy for metastatic HER2-positive breast cancer, only a limited number of patients can receive DS-8201 or T-DM1 in some parts of the world, including China. Methods:: Patients with HER2-positive MBC admitted to our hospital from January 2016 to December 2021 were selected. For patients who could not receive antibody‒drug conjugates (ADCs) during second-line (2nd-line) or third-line and beyond (≥3rd-line) anti-HER2 therapy, inetetamab + pyrotinib + vinorelbine was used for treatment until unacceptable adverse events occurred or the disease progressed, as evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 every 2 cycles. The progression-free survival (PFS), objective response rate (ORR), clinical benefit rate (CBR), and adverse reactions were recorded. Multivariate Cox regression analysis was performed to explore the prognostic factors influencing the curative effect. objective: This study will explore the efficacy and safety of the novel anti-HER2 monoclonal antibody (inetetamab) and TKI (pyrotinib) combined with the chemotherapy drug vinorelbine in the second-line and beyond treatment of metastatic HER2-positive breast cancer Results:: Overall, 52 patients were included; 13 patients received 2nd-line treatment, and 39 patients received ≥3rd-line treatment. The median PFS (mPFS) for all patients treated with inetetamab + pyrotinib + vinorelbine was 7 months. The mPFS of the 2nd-line subgroup was significantly better than that of the ≥3rd-line subgroup (17 vs. 5 months, P = 0.001). The mPFS of the subgroups that received trastuzumab (H) or trastuzumab and pertuzumab (HP) only was significantly better than that of the H or HP and tyrosine kinase inhibitor (TKI) subgroups (8 vs. 5 months, P = 0.030). The mPFS of the HER2 resistance subgroup was better than that of the HER2 refractoriness subgroup (14 vs. 7 months, P = 0.025). Cox regression analysis showed that the treatment line (2nd-line more so than ≥3rd-line) was an independent prognostic factor for PFS. In addition, the ORR and CBR of 2nd-line patients were significantly higher than those of ≥3rd-line patients (69.2% vs. 30.8% and 92.3% vs. 64.1%, respectively). The most common hematological toxicities were leukopenia and neutropenia, and the most common nonhematological toxicity was diarrhea. method: Patients with HER2-positive metastatic breast cancer (MBC) admitted to our hospital from January 2016 to December 2021 were selected. For patients who cannot receive antibody-drug conjugate (ADC) during second-line (2nd-line), or third-line and beyond (≥3rd-line) anti-HER2 therapy, inetetamab + pyrotinib + vinorelbine were used for treatment until unacceptable adverse event or progression of disease evaluated by The Response Criteria Evaluation in Solid Tumors (RECIST) 1.1 criteria every 2 cycles. The progression-free survival (PFS), objective response rate (ORR), clinical benefit rate (CBR) and the adverse reactions were recorded. Multivariate COX regression analysis were conducted to explore the prognostic factors influencing the curative effect. Conclusion:: Inetetamab and pyrotinib in combination with vinorelbine have good efficacy in ≥2ndline treatment of HER2-positive MBC with controllable toxicity, and the combination is a new treatment option, especially for patients who cannot use ADCs in 2nd-line treatment. other: None