ecancermedicalscience

Research

Her2 positive metastatic breast cancer treated with low dose lapatinib in a resource-constrained setting in South India: a retrospective audit

6 Sep 2024
Sherin P Mathew, Manuprasad Avaronnan, Nandini Devi, Praveen Kumar Shenoy V.P

Despite the development of newer anti-Her2 agents, access to these medicines is still restricted with lapatinib being widely used as a second-line agent in Her2-positive metastatic breast cancer. However, lapatinib at approved doses of 1,250 to 1,500 mg/day contributes to a high pill burden and financial toxicity. In a population that has an average national per capita income of only USD 2238.1, lapatinib alone contributes to a financial burden of USD 6153.56 per year (approximately USD 500 per month). A concept of ‘value meal’ has been suggested – the higher bioavailability of lapatinib with the meal being exploited to reduce its administered dose. This concept was utilised in a resource-constrained tertiary care center in South India and we report the outcomes. In our institution, consecutive patients with Her2 positive metastatic breast cancer from 1 January 2014 to 31 December 2020 who could not afford trastuzumab, lapatinib or any other anti-Her2 agent were offered low-dose lapatinib, 500 mg daily with meal. We conducted a retrospective cohort study of the safety and efficacy of this regimen. Among the 47 patients who received low-dose lapatinib, the majority had de novo metastatic disease (57.4%) and multiple visceral metastases (48.9%). The median number of lines of treatment before lapatinib was one. The disease control rate with lapatinib was 61.7%. The median progression-free survival was 7 months (95% CI: 5.6–8.4 months). The median duration of response was 4.5 months, ranging from 1.3 to 45.8 months. Only eleven patients (23.4%) experienced toxicity, mainly dermatological, with grade 3 in only one (2.1%) and no grade 4 toxicities. Low-dose lapatinib is a regimen that offers an acceptable disease control rate. This strategy requires further exploration, particularly for the benefit of resource-limited areas.

Related Articles

Joseph Daniels, Onesmus Iinekela Amunyela, Andrew Yaw Nyantakyi, Edwina Ayaaba Ayabilah, Judith Naa Odey Tackie, Kofi Adesi Kyei
Kamran Saeed, Kaynat Siddiqui, Hafiza Fatima Aziz, Fatima Shaukat, Shazia Kadri, Aneeta Ghulam Muhammad, Aneela Darbar, Tariq Mahmood
Akhil Kapoor, Anuj Gupta, Bipinesh Sansar, Pooja Gupta, Bal Krishna Mishra, Arpita Singh, Arvind Upadhyay, Amit Kumar, Mayank Tripathi, Zachariah Chowdhury, Shashikant Patne, Ipsita Dhal, Neha Singh, Shreya Shukla, Satyendra Narayan Singh, Lincoln Pujari, Prashanth Giridhar, Ankita Rungta Kapoor, Yash Jain, Manikandan Venkatachalam, Somnath Dey, Kunal Ranjan Vinayak
Pengkhun Nov, Yangfeng Zhang, Duanyu Wang, Syphanna Sou, Socheat Touch, Samnang Kouy, Virak Vicheth, Lilin Li, Xiang Liu, Changqian Wang, Peizan Ni, Qianzi Kou, Ying Li, Chongyang Zheng, Arzoo Prasai, Wen Fu, Wandan Li, Kunpeng Du, Jiqiang Li
Etienne Okobalemba Atenguena, Joseph Francis Nwatsock, Berthe Sabine Esson Mapoko, Lionel Fossa Tabola, Kenn Chi Ndi, Jérôme Boombhi, Paul Ndom