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Lu S, Wang J, Huang J, Sun F, Zhu J, Que Y, Li H, Guo Y, Cai R, Zhen Z, Sun X, Zhang Y. Pegylated liposomal doxorubicin combined with cyclophosphamide and vincristine in pediatric patients with relapsed/refractory solid tumor: a single-arm, open-label, phase I study. EClinicalMedicine 2024; 73:102701. [PMID: 39007065 PMCID: PMC11246015 DOI: 10.1016/j.eclinm.2024.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/16/2024] Open
Abstract
Background The combined vincristine, pegylated liposomal doxorubicin (PLD), and cyclophosphamide (VPC) regimen has never been studied in pediatric patients. Methods This open-label, single-center, single-arm phase I study utilizing a "3 + 3" design enrolled children with relapsed/refractory (R/R) solid tumors. Three dose levels of PLD (Duomeisu®) were studied (30, 40, or 50 mg/m2) in combination with cyclophosphamide (1500 mg/m2), mesna (1500 mg/m2), and vincristine (1.5 mg/m2, maximum 2 mg) once every 3 weeks. The primary endpoints included safety, the maximum tolerated dose (MTD) of PLD (Duomeisu®), and the recommended phase 2 dose (RP2D) of PLD (Duomeisu®) for further phase 2 investigation. The secondary endpoints were objective response rate (ORR) and disease control rate (DCR). This study is registered with ClinicalTrials.gov, NCT04213612. Findings Between January 7, 2020, and November 18, 2021, 34 patients were eligible and evaluable for toxicity, while 26 patients were evaluable for response. The MTD of PLD (Duomeisu®) was 30 mg/m2. The most common adverse event (AE) was grade 3 or 4 neutropenia (61.8%). The most common grade 1 or 2 non-hematologic AE and cardiotoxicity effects were vomiting (35.3%) and abnormal electrocardiogram T waves (20.6%), respectively. ORR and DCR to VPC regimen after two cycles were 50.0% and 92.3%, respectively. Targeted gene panel sequencing revealed the activation of TP53 mutation may be an adverse prognostic factor. Interpretation The VPC regimen showed a promising safety profile and had preliminary efficacy in children with R/R solid tumors. The RP2D for PLD (Duomeisu®) combined with cyclophosphamide and vincristine is 30 mg/m2 once every 3 weeks. Funding CSPC Ouyi Pharmaceutical Co., Ltd., Shijiazhuang, the National Key Research and Development Program of China [No. 2022YFC2705005], the National Natural Science Foundation of China [No. 82203303], and the Basic and Applied Basic Research Foundation of Guangdong Province [No. 2021A1515110234].
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Affiliation(s)
- Suying Lu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Juan Wang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Junting Huang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Feifei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Jia Zhu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Yi Que
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Hui Li
- Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Ying Guo
- Department of Clinical Research, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Ruiqing Cai
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Zijun Zhen
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Xiaofei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Yizhuo Zhang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
- Young Talents Program of Sun Yat-sen University Cancer Center, PR China
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Ferrero A, Borghese M, Restaino S, Puppo A, Vizzielli G, Biglia N. Predicting Response to Anthracyclines in Ovarian Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4260. [PMID: 35409939 PMCID: PMC8998349 DOI: 10.3390/ijerph19074260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
(1) Background: Anthracyclines are intriguing drugs, representing one of the cornerstones of both first and subsequent-lines of chemotherapy in ovarian cancer (OC). Their efficacy and mechanisms of action are related to the hot topics of OC clinical research, such as BRCA status and immunotherapy. Prediction of response to anthracyclines is challenging and no markers can predict certain therapeutic success. The current narrative review provides a summary of the clinical and biological mechanisms involved in the response to anthracyclines. (2) Methods: A MEDLINE search of the literature was performed, focusing on papers published in the last two decades. (3) Results and Conclusions: BRCA mutated tumors seem to show a higher response to anthracyclines compared to sporadic tumors and the severity of hand-foot syndrome and mucositis may be a predictive marker of PLD efficacy. CA125 can be a misleading marker of clinical response during treatment with anthracyclines, the response of which also appears to depend on OC histology. Immunochemistry, in particular HER-2 expression, could be of some help in predicting the response to such drugs, and high levels of mutated p53 appear after exposure to anthracyclines and impair their antitumor effect. Finally, organoids from OC are promising for drug testing and prediction of response to chemotherapy.
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Affiliation(s)
- Annamaria Ferrero
- Academic Department of Gynaecology and Obstetrics, Mauriziano Hospital, 10128 Torino, Italy;
| | - Martina Borghese
- Department of Gynecology and Obstetrics, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (M.B.); (A.P.)
| | - Stefano Restaino
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy;
| | - Andrea Puppo
- Department of Gynecology and Obstetrics, Santa Croce and Carle Hospital, 12100 Cuneo, Italy; (M.B.); (A.P.)
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynaecology, Department of Medical Area (DAME), University of Udine, “Santa Maria della Misericordia” Hospital, Azienda Sanitaria Ospedaliera Friuli Centrale, 33100 Udine, Italy;
| | - Nicoletta Biglia
- Academic Department of Gynaecology and Obstetrics, Mauriziano Hospital, 10128 Torino, Italy;
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Gil-Gil MJ, Bellet M, Bergamino M, Morales S, Barnadas A, Manso L, Saura C, Fernández-Ortega A, Garcia-Martinez E, Martinez-Jañez N, Melé M, Villagrasa P, Celiz P, Perez Martin X, Ciruelos E, Pernas S. Long-Term Cardiac Safety and Survival Outcomes of Neoadjuvant Pegylated Liposomal Doxorubicin in Elderly Patients or Prone to Cardiotoxicity and Triple Negative Breast Cancer. Final Results of the Multicentre Phase II CAPRICE Study. Front Oncol 2021; 11:645026. [PMID: 34307126 PMCID: PMC8300427 DOI: 10.3389/fonc.2021.645026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background The CAPRICE trial was designed to specifically evaluate neoadjuvant pegylated liposomal doxorubicin (PLD) in elderly patients or in those with other cardiovascular risk factors in whom conventional doxorubicin was contraindicated. The primary analysis of the study showed a pathological complete response (pCR) of 32% and no significant decreases in LVEF during chemotherapy. Here, we report important secondary study objectives: 5-year cardiac safety, disease-free survival (DFS), overall survival (OS) and breast cancer specific survival (BCSS). Methods In this multicentre, single-arm, phase II trial, elderly patients or those prone to cardiotoxicity and high risk stage II-IIIB breast cancer received PLD (35 mg/m2) plus cyclophosphamide (600 mg/m2) every 4 weeks for 4 cycles, followed by paclitaxel for 12 weeks as neoadjuvant chemotherapy (NAC). Left ventricular ejection fraction (LVEF) monitorization, electrocardiograms and cardiac questionnaires were performed at baseline, during treatment and at 9, 16, 28 and 40 weeks thereafter. The primary endpoint was pCR and 5-year cardiac safety, DFS, BCSS and OS were also analyzed. Results Between Oct 2007, and Jun 2010, 50 eligible patients were included. Median age was 73 (35-84) years, 84% were older than 65; 64% of patients suffered from hypertension, and 10% had prior cardiac disease. Most of tumors (88%) were triple negative. No significant decreases in LVEF were observed. The mean baseline LVEF was 66.6% (52-86) and after a median follow-up of 5 years, mean LVEF was 66 (54.5-73). For intention to treat population, 5-year DFS was 50% (95% CI 40.2-68.1) and 5-year OS was 56% (95%CI 41.2-68.4). There were 8 non-cancer related deaths, achieving a 5 years BCSS of 67.74% (CI 95%:54.31%- 81.18%). Conclusion At 5-year follow-up, this PLD-based NAC regimen continued to be cardiac-safe and effective in a population of very high-risk breast cancer patients. This scheme should be considered as an option in elderly patients or in those with other risks of developing cardiotoxicity. Trial Registration Number ClinicalTrials.gov reference NCT00563953.
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Affiliation(s)
- Miguel J Gil-Gil
- Department of Medical Oncology, Institut Català d'Oncologia, IDIBELL, L'Hospitalet, Spain
| | - Meritxell Bellet
- Department of Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Milana Bergamino
- Department of Medical Oncology, Institut Català d'Oncologia, IDIBELL, L'Hospitalet, Spain
| | - Serafín Morales
- Department of Medical Oncology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Agustí Barnadas
- Department of Medical Oncology, Hospital de Sant Pau, Barcelona, Spain
| | - Luís Manso
- Department of Medical Oncology, Hospital, 12 de Octubre, Madrid, Spain
| | - Cristina Saura
- Department of Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Adela Fernández-Ortega
- Department of Medical Oncology, Institut Català d'Oncologia, IDIBELL, L'Hospitalet, Spain
| | | | | | - Mireia Melé
- Department of Medical Oncology, Hospital Sant Joan, Reus, Spain
| | | | - Pamela Celiz
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - X Perez Martin
- Clinical Research Unit, Institut Català d'Oncologia, L'Hospitalet, Spain
| | - Eva Ciruelos
- Department of Medical Oncology, Hospital, 12 de Octubre, Madrid, Spain
| | - Sonia Pernas
- Department of Medical Oncology, Institut Català d'Oncologia, IDIBELL, L'Hospitalet, Spain
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Predictors of new-onset heart failure and overall survival in metastatic breast cancer patients treated with liposomal doxorubicin. Sci Rep 2020; 10:18481. [PMID: 33116159 PMCID: PMC7595106 DOI: 10.1038/s41598-020-75614-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 10/16/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the major cause of morbidity/mortality among breast cancer (BC) patients. Observation of the daily practice in eight experienced Polish oncology centers was conducted to find all possible predictors of new cases of heart failure (HF) and overall survival (OS) of metastatic BC patients treated with liposomal doxorubicin, taking into account the impact of pre-existing CVDs. HF was the cause of premature discontinuation of liposomal doxorubicin therapy in 13 (3.2%) of 402 patients. The probability of developing HF was higher in women with pre-existing CVDs (HR 4.61; 95%CI 1.38–15.38). Independent of CVDs history, a lower risk of HF was observed in those treated with a cumulative dose of liposomal doxorubicin > 300 mg/m2 (HR 0.14; 95% CI 0.04–0.54) and taxane-naive (HR 0.26; 95% CI 0.07–0.96). Multivariate analysis including the presence of pre-existing CVDs and occurrence of new HF, revealed a liposomal doxorubicin in cumulative doses of > 300 mg/m2 as a beneficial predictor for OS (HR 0.61; 95% CI 0.47–0.78) independently of subsequent chemotherapy (HR 0.72; 95% CI 0.57–0.92) or endocrine therapy (HR 0.65; 95% CI 0.49–0.87). Higher doses of liposomal doxorubicin can decrease mortality in metastatic BC without increasing the risk of HF. The clinical benefit is achieved regardless of pre-existing CVDs and subsequent anticancer therapy.
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Cheng M, Song Z, Qi Y, Wang X, Zhang L, Shi J, Wang M. A Dose-Escalating Pilot Study (NCT03017404) of Pegylated Liposomal Doxorubicin and Cyclophosphamide, Followed by Docetaxel Administration as a Neoadjuvant Chemotherapy Regimen in Patients with Locally Advanced Breast Cancer. Oncol Res Treat 2019; 42:269-274. [PMID: 30943501 DOI: 10.1159/000498993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pegylated liposomal doxorubicin (PEG-LD) has a comparable efficacy but a distinct toxicological profile compared with free doxorubicin. The use of PEG-LD and cyclophosphamide followed by docetaxel regimen as neoadjuvant chemotherapy has not been well established. OBJECTIVES We aimed to assess the maximum tolerated dose (MTD) and toxicity of this regimen in patients with locally advanced breast cancer. METHODS A total of 19 patients were enrolled in this trial. In the initial treatment plan, patients were given PEG-LD at 35, 40, 45, or 50 mg/m2 on day 1 during the first four cycles, and cyclophosphamide was administered at a dose of 600 mg/m2. During the last four cycles, docetaxel was administered at 75 mg/m2 on day 1 of a 21-day scheme. RESULTS The MTD was 40 mg/m2 PEG-LD and 600 mg/m2 cyclophosphamide administered on day 1 of a 21-day cycle. Dose-limiting toxicity, grade 3 hand-foot syndrome, was observed in one patient during level 2 and three patients during level 3. Other side effects included neutropenia, anemia, stomatitis, rash, nausea/vomiting, alopecia, transaminase elevation, and cardiotoxicity. The pathological complete response rate was 21.1%. CONCLUSIONS Our study demonstrated that combination of 40 mg/m2 PEG-LD and 600 mg/m2 cyclophosphamide, followed by 75 mg/m2 docetaxel on day 1 of a 21-day scheme, was an efficacious and well-tolerated neoadjuvant regimen for patients with locally advanced breast cancer.
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Affiliation(s)
- Meng Cheng
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China,
| | - Zhenchuan Song
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yixin Qi
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinle Wang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lina Zhang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiajie Shi
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mingxia Wang
- Office of Clinical Trials, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Lorusso D, Sabatucci I, Maltese G, Lepori S, Tripodi E, Bogani G, Raspagliesi F. Treatment of recurrent ovarian cancer with pegylated liposomal doxorubicin: a reappraisal and critical analysis. TUMORI JOURNAL 2019; 105:282-287. [PMID: 30917765 DOI: 10.1177/0300891619839308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The vast majority of ovarian cancer relapses on front-line therapy and the optimal treatment of recurrent ovarian cancer remains controversial. This review is based on the relevant published literature indexed in PubMed on pegylated liposomal doxorubicin (PLD), either alone or in combination with other drugs, as one option in relapsed disease. PLD showed an improved pharmacokinetic profile, with a slower plasma clearance and a longer circulation time, compared to other conventional doxorubicin formulations. PLD is considered to have little potential for cardiotoxicity, even at prolonged and high cumulative doses, although there appears to be room for improvement in terms of maximal dose allowed. Notwithstanding, there remain some concerns about cardiac safety, and patient monitoring is generally advocated. No data are available on the possibility to rechallenge PLD treatment in recurrent ovarian cancer, as already known for other drugs. Optimization of treatment regimens with PLD will allow a more rational treatment in advanced ovarian cancers for which few therapeutic options are available.
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Affiliation(s)
- Domenica Lorusso
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
| | - Ilaria Sabatucci
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
| | - Giuseppa Maltese
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
| | - Stefano Lepori
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
| | - Elisa Tripodi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Tumori di Milano, IRCCS National Cancer Institute, Milan, Italy
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Phase I/II Trial of Combined Pegylated Liposomal Doxorubicin and Cyclophosphamide in Metastatic Breast Cancer. Clin Breast Cancer 2018; 18:e143-e149. [DOI: 10.1016/j.clbc.2017.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/08/2017] [Accepted: 10/01/2017] [Indexed: 12/29/2022]
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Miglietta F, Dieci M, Griguolo G, Guarneri V, Conte P. Chemotherapy for advanced HER2-negative breast cancer: Can one algorithm fit all? Cancer Treat Rev 2017; 60:100-108. [DOI: 10.1016/j.ctrv.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 12/28/2022]
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Shafei A, El-Bakly W, Sobhy A, Wagdy O, Reda A, Aboelenin O, Marzouk A, El Habak K, Mostafa R, Ali MA, Ellithy M. A review on the efficacy and toxicity of different doxorubicin nanoparticles for targeted therapy in metastatic breast cancer. Biomed Pharmacother 2017; 95:1209-1218. [PMID: 28931213 DOI: 10.1016/j.biopha.2017.09.059] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/04/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022] Open
Abstract
In metastatic breast cancer (MBC), the conventional doxorubicin (DOX) has various problems due to lack of selectivity with subsequent therapeutic failure and adverse effects. DOX- induced cardiotoxicity is a major problem that necessitates the presence of new forms to decrease the risk of associated morbidity. Nanoparticles (NPs) are considered an important approach to selectively increase drug accumulation inside tumor cells and thus decreasing the associated side effects. Tumor cells develop resistance to chemotherapeutic agents through multiple mechanisms, one of which is over expression of efflux transporters. Various NPs have been investigated to overcome efflux mediated resistance. To date, only liposomal doxorubicin (LD) and pegylated liposomal doxorubicin (PLD) have entered phase II and III clinical trials and FDA- approved for clinical use in MBC. This review addresses the effects of LD and PLD on the hematological and palmar-plantar erythrodysesthesia (PPE) in anthracycline naïve and pretreated MBC patients. For evidence, studies to be included in this review were identified through PubMed, Cochrane and Google scholar databases. The results derived from: four phase III clinical trials that compared LD with the conventional DOX in naïve MBC patients, and ten non-comparative clinical trials investigated LD and PLD as monotherapy or combination in pretreated MBC. This work confirmed the cardiac tolerability profile of LD and PLD versus DOX, while hematological and skin toxicities were more common. Other DOX-NPs in preclinical trials were discussed in a chronological order. Finally, the modern preclinical development framework for DOX includes exosomal DOX (exo-DOX). Exosomal NPs are non-toxic, non-immunogenic, and can be engineered to have high cargo loading capacity and targeting specificity. These NPs have not been investigated clinically. Our study shows that the full clinical potentiality of DOX-NPs remains to be addressed to move the field forward.
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Affiliation(s)
- Ayman Shafei
- Biomedical Research Department, Armed Forces College of Medicine, Cairo, Egypt
| | - Wesam El-Bakly
- Pharmacology Department, Faculty of Medicine, Ain Shams University, Egypt.
| | | | | | | | | | | | | | - Randa Mostafa
- Biomedical Research Department, Armed Forces College of Medicine, Cairo, Egypt
| | - Mahmoud A Ali
- Biomedical Research Department, Armed Forces College of Medicine, Cairo, Egypt
| | - Mahmoud Ellithy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Egypt
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Schmidt M. Dose-Dense Chemotherapy in Metastatic Breast Cancer: Shortening the Time Interval for a Better Therapeutic Index. Breast Care (Basel) 2015; 11:22-6. [PMID: 27051392 DOI: 10.1159/000442726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite the advancement of targeted therapies in metastatic breast cancer, chemotherapy is still of pivotal importance. The concept of dose density is known to increase the efficacy of chemotherapy. In metastatic disease, preservation of the quality of life is equally important. Because of this, weekly regimens are a cornerstone in metastatic disease. Taxanes like paclitaxel or nab-paclitaxel as well as antracyclines are often used in palliative treatment. Further advances to increase dose density have led to the concept of daily metronomic schedules with oral chemotherapeutic drugs like cyclophosphamide, capecitabine, or vinorelbine. Metronomic chemotherapy affects tumor angiogenesis and also weakens immunosuppressive regulatory T cells, promoting better control of tumor progression. Weekly or daily dose-dense regimens are a reasonable compromise between efficacy and toxicity to improve the therapeutic index. This is most important for the treatment of chronic disease where palliation and preservation of quality of life are vital.
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Affiliation(s)
- Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg-University, Mainz, Germany
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Geretti E, Leonard SC, Dumont N, Lee H, Zheng J, De Souza R, Gaddy DF, Espelin CW, Jaffray DA, Moyo V, Nielsen UB, Wickham TJ, Hendriks BS. Cyclophosphamide-Mediated Tumor Priming for Enhanced Delivery and Antitumor Activity of HER2-Targeted Liposomal Doxorubicin (MM-302). Mol Cancer Ther 2015; 14:2060-71. [DOI: 10.1158/1535-7163.mct-15-0314] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
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Pegylated liposomal doxorubicin plus cyclophosphamide followed by paclitaxel as primary chemotherapy in elderly or cardiotoxicity-prone patients with high-risk breast cancer: results of the phase II CAPRICE study. Breast Cancer Res Treat 2015; 151:597-606. [PMID: 25981896 DOI: 10.1007/s10549-015-3415-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
Anthracycline and taxane-based primary chemotherapy (PCT) is the standard treatment for high-risk breast cancer (HRBC). However, conventional anthracyclines are not commonly used in elderly patients or those prone to cardiotoxicity. Pegylated liposomal doxorubicin, (PLD) has comparable efficacy, but less cardiotoxicity than conventional anthracyclines. We conducted a phase II single-arm trial to assess the efficacy and safety of PCT based on PLD followed by paclitaxel (PTX) in a HRBC population usually undertreated. Fifty patients with stage II-IIIB breast cancer and at least one risk factor for developing cardiotoxicity initiated PLD 35 mg/m(2) plus cyclophosphamide 600 mg/m(2) every 4 weeks for four cycles, followed by 80 mg/m(2) weekly PTX for 12. Close cardiac monitoring was performed. Primary endpoint was the pathological complete response rate (pCR) in the breast. Treatment delivery and toxicities were assessed. Eighty-four per cent of patients were older than 65 years, 64 % suffered from hypertension, and 10 % had prior cardiac disease. In an intention-to-treat analysis, breast pCR was 32 % (95 % CI 19.5-46.7 %) and pCR in breast and axilla was 24 % (95 % CI 12.1-35.8 %). At diagnosis only, 26 % of patients were candidates for breast conservative surgery, which increased to 58.7 % after PCT. No significant decrease in left ventricular ejection fraction was seen. PLD followed by PTX was feasible in a fragile population of patients who were not candidates for conventional doxorubicin. Moreover, it achieved a pCR similar to standard therapy and could therefore be an option for elderly patients or cardiotoxicity-prone who present HRBC.
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Pegylated liposomal doxorubicin and cyclophosphamide in early recurrent ovarian carcinoma: phase I dose-finding study. Cancer Chemother Pharmacol 2013; 73:61-8. [DOI: 10.1007/s00280-013-2317-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022]
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14
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The Future of Chemotherapy in the Era of Personalized Medicine. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-012-0094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vanderbeeken MC, Aftimos PG, Awada A. Topoisomerase Inhibitors in Metastatic Breast Cancer: Overview of Current Practice and Future Development. CURRENT BREAST CANCER REPORTS 2013. [DOI: 10.1007/s12609-012-0098-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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16
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Rayson D, Suter T, Jackisch C, van der Vegt S, Bermejo B, van den Bosch J, Vivanco G, van Gent A, Wildiers H, Torres A, Provencher L, Temizkan M, Chirgwin J, Canon J, Ferrandina G, Srinivasan S, Zhang L, Richel D. Cardiac safety of adjuvant pegylated liposomal doxorubicin with concurrent trastuzumab: a randomized phase II trial. Ann Oncol 2012; 23:1780-8. [DOI: 10.1093/annonc/mdr519] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Collea RP, Kruter FW, Cantrell JE, George TK, Kruger S, Favret AM, Lindquist DL, Melnyk AM, Pluenneke RE, Shao SH, Crockett MW, Asmar L, O'Shaughnessy J. Pegylated liposomal doxorubicin plus carboplatin in patients with metastatic breast cancer: a phase II study. Ann Oncol 2012; 23:2599-2605. [PMID: 22431702 DOI: 10.1093/annonc/mds052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We determined the objective response rates produced by pegylated liposomal doxorubicin (PLD) plus carboplatin with/without trastuzumab (Herceptin). PATIENTS AND METHODS Patients with measurable disease were stratified by taxane treatment history and human epidermal growth factor receptor-2 status. TREATMENT PLD 30 mg/m(2) followed by carboplatin, day 1 of each 28-day cycle; human epidermal growth factor receptor-2 (HER2)-positive patients also received trastuzumab. RESULTS Arm 1 received PLD plus carboplatin (N = 41 arm 1a, taxane naive; N = 42 arm 1b, taxane pretreated); Arm 2 patients received PLD plus carboplatin + Herceptin (N = 46). Overall response rates: 31%, 31%, and 56%, respectively. Median overall survival durations were not reached in arm 1a and were 13 and 33 months for arms 1b and 2. Median progression-free survival: 8, 5, 10 months, respectively. Grades 3-4 treatment-related toxic effects for arms 1a, 1b, 2, respectively, were neutropenia 22%, 31%, 35%; thrombocytopenia 34%, 26%, 17%; and fatigue 2%, 14%, 13%. CONCLUSIONS PLD plus carboplatin has moderate antitumor activity and excellent tolerability. Herceptin and PLD plus carboplatin in HER2-positive patients have antitumor activity without significant cardiac toxicity. Toxicity results suggest that PLD can be combined with Herceptin with minimal cardiac toxicity.
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Affiliation(s)
- R P Collea
- US Oncology Research, McKesson Specialty Health, The Woodlands; New York Oncology Hematology Center, Albany.
| | - F W Kruter
- US Oncology Research, McKesson Specialty Health, The Woodlands; Alliance Hematology-Oncology PA, Westminster
| | - J E Cantrell
- US Oncology Research, McKesson Specialty Health, The Woodlands; Birmingham Hematology-Oncology, Birmingham
| | - T K George
- US Oncology Research, McKesson Specialty Health, The Woodlands; Texas Oncology, Odessa
| | - S Kruger
- US Oncology Research, McKesson Specialty Health, The Woodlands; Virginia Oncology Associates, Hampton
| | - A M Favret
- US Oncology Research, McKesson Specialty Health, The Woodlands; Northern Virginia Hematology-Oncology, Fairfax
| | - D L Lindquist
- US Oncology Research, McKesson Specialty Health, The Woodlands; Arizona Oncology, Sedona
| | - A M Melnyk
- US Oncology Research, McKesson Specialty Health, The Woodlands; Texas Oncology, Abilene
| | - R E Pluenneke
- US Oncology Research, McKesson Specialty Health, The Woodlands; Kansas City Cancer Center, Kansas City
| | - S H Shao
- US Oncology Research, McKesson Specialty Health, The Woodlands; Northwest Cancer Specialists, Portland
| | - M W Crockett
- US Oncology Research, McKesson Specialty Health, The Woodlands
| | - L Asmar
- US Oncology Research, McKesson Specialty Health, The Woodlands
| | - J O'Shaughnessy
- US Oncology Research, McKesson Specialty Health, The Woodlands; Texas Oncology, PA, Baylor-Charles A. Sammons Cancer Center, Dallas, USA
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Coleman RE, Bertelli G, Beaumont T, Kunkler I, Miles D, Simmonds PD, Jones AL, Smith IE. UK guidance document: treatment of metastatic breast cancer. Clin Oncol (R Coll Radiol) 2011; 24:169-76. [PMID: 22075442 DOI: 10.1016/j.clon.2011.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 12/25/2022]
Abstract
Although there have been major improvements in the management of breast cancer, with a rapidly falling death rate despite an increasing incidence of the disease, metastatic breast cancer remains common and the cause of death in nearly 12 000 women annually in the UK. Numerous treatment options are available that either target the tumour or reduce the complications of the disease. Clinical decision making depends on knowledge of the extent and biology of the disease and available drug options, an understanding of the functional status, and also the wishes and expectations of the individual patient. In addition, the organisation of services and support of the patient are essential components of high-quality care. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for the treatment of advanced breast cancer, which in some areas have perhaps failed to appreciate the complexity of patient management. This guidance document aims to provide succinct practical advice on the treatment of metastatic breast cancer, highlight some limitations of the NICE guidelines, and provide suggestions for management where available data are limited.
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Affiliation(s)
- R E Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
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Curtit E, Nouyrigat P, Dohollou N, Levy E, Lortholary A, Gligorov J, Facchini T, Jaubert D, Maille N, Pivot X, Grangé V, Cals L. Myotax: a phase II trial of docetaxel plus non-pegylated liposomal doxorubicin as first-line therapy of metastatic breast cancer previously treated with adjuvant anthracyclines. Eur J Cancer 2011; 47:2396-402. [PMID: 21920729 DOI: 10.1016/j.ejca.2011.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 08/05/2011] [Accepted: 08/15/2011] [Indexed: 11/16/2022]
Abstract
AIM Non-pegylated liposomal doxorubicin (NPLD) has demonstrated equivalent antitumour activity to conventional doxorubicin and a significantly lower risk of cardiotoxicity when given as a single agent or in combination with cyclophosphamide. This phase II trial was performed to evaluate the efficacy and the safety of NPLD and docetaxel combination in patients with metastatic breast cancer previously exposed to adjuvant anthracyclines. PATIENTS AND METHODS Thirty-four patients received NPLD 60 mg/m(2) and docetaxel 75 mg/m(2) in a 21-day cycle as first-line therapy of metastatic breast cancer. Treatment was planned for six cycles and was continued until progression or toxicity. RESULTS Objective response rate among response-assessable patients was 79% (95% CI (confidence interval), 64-94%) and 27% (95% CI, 11-43%) presented a complete response. Median progression free survival was 11.3 months (95% CI, 6.2-13.3 months) and median overall survival was 28.2 months (95% CI, 16-36.4 months). Symptomatic grade 3 cardiotoxicity occurred in 15% of cases and febrile neutropenia in 47% of the patients. CONCLUSIONS The combination of NPLD and docetaxel demonstrated high antitumour activity in a population of metastatic breast cancer patients exposed to adjuvant anthracyclines and showed an unexpected and unexplained 15% symptomatic left ventricular systolic dysfunction rate.
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Affiliation(s)
- E Curtit
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon, France
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Johnston SR. The role of chemotherapy and targeted agents in patients with metastatic breast cancer. Eur J Cancer 2011; 47 Suppl 3:S38-47. [DOI: 10.1016/s0959-8049(11)70145-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Göppner D, Quist SR, Franke I, Ulrich J, Drecoll U, Bürger T, Gollnick HPM, Bonnekoh B. Selective regional perfusion of the bilateral external carotid arteries with pegylated liposomal doxorubicin and melphalan to treat metastatic malignant melanoma of the scalp. Clin Exp Dermatol 2011; 36:270-2. [DOI: 10.1111/j.1365-2230.2010.03906.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martín M, Sánchez-Rovira P, Muñoz M, Baena-Cañada JM, Mel JR, Margeli M, Ramos M, Martínez E, García-Saenz JA, Casado A, Jaén AM, González-Farré X, Escudero MJ, Rodriguez-Martin C, Carrasco E. Pegylated liposomal doxorubicin in combination with cyclophosphamide and trastuzumab in HER2-positive metastatic breast cancer patients: efficacy and cardiac safety from the GEICAM/2004-05 study. Ann Oncol 2011; 22:2591-2596. [PMID: 21421542 DOI: 10.1093/annonc/mdr024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In order to determine the feasibility of substituting pegylated liposomal doxorubicin (PLD) for doxorubicin in combination with cyclophosphamide and trastuzumab as adjuvant therapy, we conducted a phase II study of the combination as first-line therapy in human epidermal growth factor receptor 2 (HER2) overexpressing metastatic breast cancer (MBC). METHODS PLD 50 mg/m(2) and cyclophosphamide 600 mg/m(2) were administered every 4 weeks for six cycles; trastuzumab (4 mg/kg loading dose, then 2 mg/kg) was administered weekly for 24 weeks. The primary end point was objective response rate (ORR), and the secondary end points included time to progression (TTP), overall survival (OS), and safety. RESULTS Among the 48 evaluable patients, ORR was 68.8% [95% confidence interval (CI) 55.69% to 81.91%], with 6 patients (12.5%) achieving a complete response and 27 (56.2%) a partial response. The median TTP was 12 months (95% CI 9-15.1 months), and the median OS was 34.2 months (95% CI 27.2-41.2 months). Febrile neutropenia was seen in three patients, grade 3 hand-foot syndrome in 29.2% of patients, and grade 3-4 mucositis in 22.9% of patients. Symptomatic congestive heart failure was not observed, and 16.7% of patients experienced grade 2 asymptomatic left ventricular systolic dysfunction. CONCLUSION The combination of PLD-cyclophosphamide-concurrent trastuzumab is a feasible, safe, and effective first-line regimen for HER2-overexpressing MBC.
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Affiliation(s)
- M Martín
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid.
| | - P Sánchez-Rovira
- Medical Oncology Departmanet, Complejo Hospitalario de Jaén, Jaén
| | - M Muñoz
- Medical Oncology Department, Hospital Clinic i Provincial, Barcelona
| | | | - J R Mel
- Medical Oncology Department, Hospital Xeral Calde, Lugo
| | - M Margeli
- Medical Oncology Department, Hospital Germans Trias y Pujol, Badalona
| | - M Ramos
- Medical Oncology Department, Centro Oncologico de Galicia, A Coruña
| | - E Martínez
- Medical Oncology Department, Hospital Provincial de Castellón, Castellón
| | - J A García-Saenz
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid
| | - A Casado
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid
| | - A M Jaén
- Medical Oncology Departmanet, Complejo Hospitalario de Jaén, Jaén
| | - X González-Farré
- Medical Oncology Department, Hospital Clinic i Provincial, Barcelona
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Al-Batran SE, Güntner M, Pauligk C, Scholz M, Chen R, Beiss B, Stopatschinskaja S, Lerbs W, Harbeck N, Jäger E. Anthracycline rechallenge using pegylated liposomal doxorubicin in patients with metastatic breast cancer: a pooled analysis using individual data from four prospective trials. Br J Cancer 2010; 103:1518-23. [PMID: 20978502 PMCID: PMC2990592 DOI: 10.1038/sj.bjc.6605961] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/17/2010] [Accepted: 09/24/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the activity of anthracycline rechallenge using pegylated liposomal doxorubicin (PLD) in patients with metastatic breast cancer (MBC) previously treated with conventional anthracyclines. METHODS Pooled individual data from four prospective trials were used, and the primary end point of the pooled analysis was clinical benefit rate (CBR). The studies comprised 935 patients, of whom 274 had received PLD in the metastatic setting after prior exposure to conventional anthracyclines (rechallenge population). RESULTS The majority of patients were heavily pretreated. Previous anthracycline therapy was administered in the adjuvant (14%) or metastatic setting (46%), or both (40%). The overall CBR from rechallenge with PLD was 37.2% (95% CI, 32.4-42.0). In univariate analyses, the CBR was significantly higher in patients with less exposure to prior chemotherapy, in taxane-naive patients, and in patients with a favourable Eastern Cooperative Group performance status of 0 vs 1 vs 2 (53.3 vs 35.5 vs 18.2%; P<0.001). In multivariate analyses, performance status proved to be the only independent predictor of the CBR achieved with PLD rechallenge (P=0.038). There was no statistically significant difference in CBR regarding the setting, cumulative dose of and/or resistance to prior anthracyclines, or time since prior anthracycline administration. CONCLUSION Anthracycline rechallenge using PLD is effective in patients with MBC who have a favourable performance status, regardless of setting, resistance, cumulative dose or time since prior conventional anthracycline therapy.
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Affiliation(s)
- S-E Al-Batran
- Klinik für Onkologie und Hämatologie am Krankenhaus Nordwest, Krankenhaus Nordwest, Steinbacher Hohl 2-26, 60488 Frankfurt am Main, Germany.
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Abstract
Adjuvant use of anthracycline-taxane combination therapy is an accepted strategy in the management of high-risk early-stage breast cancer. However, the introduction of this regimen raises the question of how best to manage those patients who relapse following adjuvant therapy, and whether there is a role for rechallenging in the metastatic setting with the same agent, or class of agent, that has been utilized in the adjuvant setting. This Review examines the evidence for rechallenging with both anthracyclines and taxanes, and highlights the issues that need to be examined in the context of future clinical trials.
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Montemurro F, Rossi V, Nolè F, Redana S, Donadio M, Martinello R, Verri E, Valabrega G, Rocca MC, Jacomuzzi ME, Viale G, Sapino A, Aglietta M. Underuse of anthracyclines in women with HER-2+ advanced breast cancer. Oncologist 2010; 15:665-72. [PMID: 20576644 PMCID: PMC3228005 DOI: 10.1634/theoncologist.2010-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article examines how discouraging the use of anthracyclines in combination with trastuzumab in patients with human epidermal growth factor receptor 2 positive metastatic breast cancer because of fears of cardiotoxicity has influenced the use of these agents in this patient setting. Anthracyclines are among the most active drugs in breast cancer. Because of excessive cardiotoxicity, their use in combination with trastuzumab has been discouraged in patients with human epidermal growth factor receptor (HER)-2+ metastatic breast cancer. We sought to describe how this treatment paradigm influenced the use of anthracyclines in this patient setting. We analyzed a multi-institutional database containing the treatment history of 450 patients who received at least one trastuzumab-based regimen for HER-2+ metastatic breast cancer. Patients were considered eligible for anthracyclines for metastatic disease if they were never exposed (NE) or had been previously exposed (PE) to an anthracycline in the neoadjuvant or adjuvant setting and had relapsed after 12 months from the last dose. We then assessed the use of anthracycline-based therapy after failure with the first trastuzumab-based regimen in eligible patients. Three-hundred twenty-one patients were considered eligible for anthracyclines. In total, 190 eligible patients developing disease progression during the initial trastuzumab-based therapy were analyzed. An anthracycline was administered as first salvage treatment in 14 NE and two PE patients. Another 15 NE and nine PE patients received an anthracycline as a further line of therapy. Of 119 eligible patients who died from breast cancer, only 30 received an anthracycline for metastatic disease. In conclusion, despite the fact that two thirds of the patients receiving trastuzumab-based therapy for HER-2 metastatic breast cancer are eligible for anthracyclines, these drugs are infrequently used nowadays to treat trastuzumab-refractory disease. A role for these compounds should be redefined in this patient subset.
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Affiliation(s)
- Filippo Montemurro
- Division of Medical Oncology I, Fondazione del Piemonte per L'Oncologia, Institute for Cancer Research and Treatment, 10060 Candiolo, Torino, Italy.
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Chuang E, Wiener N, Christos P, Kessler R, Cobham M, Donovan D, Goldberg GL, Caputo T, Doyle A, Vahdat L, Sparano JA. Phase I trial of ixabepilone plus pegylated liposomal doxorubicin in patients with adenocarcinoma of breast or ovary. Ann Oncol 2010; 21:2075-2080. [PMID: 20357034 DOI: 10.1093/annonc/mdq080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ixabepilone is a semisynthetic epothilone B analogue that is active in taxane-resistant cell lines and has shown activity in patients with refractory breast and ovarian cancer. We carried out a phase I trial of ixabepilone plus pegylated liposomal doxorubicin (PLD) in patients with advanced taxane-pretreated ovarian and breast cancer. METHODS Patients with recurrent ovarian or breast carcinoma received PLD every 3 or 4 weeks plus five different dose schemas of ixabepilone in cohorts of three to six patients. RESULTS Thirty patients received a total of 142 treatment cycles of the PLD-ixabepilone combination. The recommended phase II dose and schedule of ixabepilone was 16 mg/m(2) on days 1, 8, and 15 plus PLD 30 mg/m(2) given on day 1, repeated every 4 weeks. Hand-foot syndrome and mucositis were dose limiting when both ixabepilone and PLD were given every 3 or 4 weeks. Objective responses were observed in 3 of 13 patients (23%) with breast cancer and 5 of 17 patients (29%) with ovarian cancer. CONCLUSION Ixabepilone may be safely combined with PLD, but tolerability is highly dependent upon the scheduling of both agents. This combination demonstrated efficacy in patients with breast and ovarian cancer and merits further evaluation in these settings.
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Affiliation(s)
| | | | - P Christos
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College, New York, NY
| | | | | | | | - G L Goldberg
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - T Caputo
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
| | - A Doyle
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | | | - J A Sparano
- Department of Medicine and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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