Vinorelbine-based salvage therapy in HER2-positive metastatic breast cancer patients progressing during trastuzumab-containing regimens: a retrospective study
The vinka-alkaloyd vinorelbine is a potentially valuable treatment in patients with HER2-positive, trastuzumab-resistant advanced breast cancer. We sought to document the clinical activity of vinorelbine-based salvage treatments in this clinical setting.
Methods: We analyzed a cohort of 424 consecutive women receiving trastuzumab-based therapy for HER2-positive advanced breast cancer.
Of these, 299 were identified as progressing during the initial trastuzumab-based treatment, and 77 received vinorelbine-based therapy as first salvage treatment. Central review of pathological specimens revealed that 70 patients had HER2-amplification detected by FISH.
For these patients we determined overall response rate (ORR = complete-CR + partial-PR) and clinical benefit (CB = CR+PR+Stable disease lasting at least 6 months), time to progression (TTP) and overall survival (OS) from the initiation of vinorelbine-based salvage therapy.
Results: In 60 patients who were evaluable for tumor response, ORR and CB rates were 28% (95% C.I.
18%-41%) and 50% (95% C.I. 38%-62%), respectively.
Median follow-up from the initiation of salvage therapy was 15 months (range 1-63 months). Median TTP and OS were 7.1 months (95% C.I.
6.6-7.7 months) and 21 months (95% C.I. 14.3-27.7 months), respectively.
No differences in clinical outcomes were observed according to whether vinorelbine was administered as a single agent or in combination with other cytostatics, or whether trastuzumab was stopped or continued beyond disease progression.
Conclusions: Our findings suggests that vinorelbine-based combinations are active and should be further evaluated in studies conducted in trastuzumab-resistant patients, including those evaluatingnewer HER2-targeting agents.
Author: Filippo Montemurro, Stefania Redana, Franco Nole, Michela Donadio, Maria Elena Jacomuzzi, Giorgio Valabrega, Giuseppe Viale, Anna Sapino and Massimo Aglietta
Credits/Source: BMC Cancer 2008, 8:209
Published on: 2008-07-24
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