Testing the Use of Neratinib or the Combination of Neratinib and Palbociclib Targeted Treatment for HER2+ Solid Tumors (A ComboMATCH Treatment Trial)

Inclusion Criteria:

• Patient must have enrolled onto EAY191 and must have been given a treatment assignment to ComboMATCH to EAY191-N5 based on the presence of an actionable mutation as defined in EAY191

• Patients must have a HER2 amplified solid tumor except breast cancer.

• If IHC is 0 or 1+, patient (pt) is NOT ELIGIBLE regardless of in situ hybridization (ISH)/FISH or next generation sequencing (NGS) status

• If IHC is 3+, pt IS ELIGIBLE regardless of ISH/FISH or NGS status

• If IHC is 2+, ISH/FISH OR NGS must be positive for the patient to be ELIGIBLE. Otherwise, pt is NOT ELIGIBLE

• If IHC is unknown and…

• ISH/FISH is positive, independent of NGS results, the patient IS ELIGIBLE

• ISH/FISH is negative and NGS positive with ≥ 7 copies, the patient IS ELIGIBLE

• Patients must have recurrent or persistent disease

• No known evidence of RB1 loss or deletion including copy number loss or deleterious mutation

• Patients must have disease that can be safely biopsied and agree to a pre-treatment biopsy or, if disease cannot be safely biopsied, have archival tissue available from within 12 months prior to the date of registration on the ComboMATCH Registration Trial (EAY191)

• Patients must have measurable disease based on RECIST 1.1. A second measurable lesion outside of the biopsiable lesion is required

• Patients with treated brain metastases are eligible if follow up brain imaging after central nervous system (CNS) directed therapy shows no evidence of progression for 3 months or more and patient is not on steroids and is asymptomatic

• No known leptomeningeal disease

• Patients may have received up to 5 prior lines of systemic therapy

• Prior therapy with trastuzumab or pertuzumab, either alone or in combination, antibody drug conjugates (ADC) such as DS8201a or T-DM1 is allowed

• No prior therapy with HER2 targeting tyrosine kinase inhibitors (TKI) such as neratinib or tucatinib

• No prior therapy with CDK4/6 inhibition

• No cancer directed therapy within 3 weeks prior to registration. For oral therapy, the washout can be reduced to greater than or equal to 5 half lives of the drug. No HER2 targeting ADCs within 30 days prior to registration

• Age ≥ 18

• Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 2

• Not pregnant and not nursing

• Absolute neutrophil count (ANC) ≥ 1,500 cells/mm^3

• Platelets ≥ 100,000 cells/mm^3

• Hemoglobin ≥ 9 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin (Hgb) ≥ 9 g/dl is acceptable)

• Creatinine clearance (CrCL) of ≥ 30 mL/min by the Cockcroft-Gault formula

• Total bilirubin level ≤ 1.5 x institutional upper limit of normal (ULN) (patients with known Gilbert's disease who have bilirubin level ≤ 3 x institutional ULN may be enrolled)

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 x institutional upper limit of normal (ULN)

• Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better

• No active infection requiring parenteral antibiotics

• No current evidence of intra-abdominal abscess, abdominal/pelvic fistula (not diverted), gastrointestinal perforation, gastrointestinal (GI) obstruction, and/or need for drainage nasogastric or gastrostomy tube

• No current evidence of malabsorption or chronic diarrhea or any other significant gastro-intestinal disease (e.g gastrectomy, ileal bypass, Crohn's disease, gastroparesis), associated with moderate to severe diarrhea (grade 2 or more) or inability to tolerate oral therapy

• No lung disease causing dyspnea at rest

• No interstitial lung disease with ongoing signs and symptoms at the time of registration

• No history of allergic reaction to the study agents, compound of similar chemical or biologic composition of the study agents or any of their excipients