title: Efficacy and safety of combined trastuzumab and Paclitaxel therapy as a second-line treatment in women with metastatic breast cancer: a single institutional experience.
abstract: BACKGROUND
  In breast cancer, HER-2 overexpression suggests s poor prognosis. Trastuzumab is a humanized monoclonal antibody with specificity to the HER-2 protein. We evaluated the safety and efficacy of combined trastuzumab and paclitaxel therapy in women with metastatic breast cancer.
  
  
  METHODS
  Combination chemotherapy was given to patients with HER-2 overexpressing metastatic breast cancer. All patients had previously received one or more chemotherapy treatments. Patients received a loading trastuzumab dose of 4 mg/kg intravenously (i.v.), followed by 2 mg/kg maintenance dose at weekly intervals. A paclitaxel dose of 80 mg/m(2) was administered on the same day as the trastuzumab infusion.
  
  
  RESULTS
  A total of 53 patients were examined. Seventy percent received two or more prior chemotherapy treatments for metastatic breast cancer, and 66.0% of patients had two or more metastatic sites. The overall response rate to our approach was 37.7%. Median time to progression was 12.0 months. Grade 3/4 neutropenia was seen in only 11.3% of patients. Peripheral neuropathy occurred in 65.1% of patients after seven treatments, requiring us to change to biweekly paclitaxel administration in 16 patients. Most of them were able to continue the treatment. Other toxicities were mild and tolerable.
  
  
  CONCLUSIONS
  Combined trastuzumab and paclitaxel therapy, administered as second-line or later treatment, produced lasting objective responses and was well tolerated by women with HER-2 overexpressing metastatic breast cancer. A major obstacle to continuing treatment was peripheral neuropathy. However, modifying the interval to every 2 weeks enabled us to continue the treatment. This combination chemotherapy was safely performed in our outpatient clinic.
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital, Tokyo, Japan. keikofuru@triton.ocn.ne.jp
authors.forename: Keiko
authors.initials: K
authors.lastname: Furukawa
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.forename: Shunji
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masataka
authors.initials: M
authors.lastname: Sawaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Mizunuma
authors.forename: Noboru
authors.initials: N
authors.lastname: Horikoshi
authors.forename: Fujio
authors.initials: F
authors.lastname: Kasumi
authors.forename: Futoshi
authors.initials: F
authors.lastname: Akiyama
authors.forename: Goi
authors.initials: G
authors.lastname: Sakamoto
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hatake
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D009503:Neutropenia / Q000139:chemically induced; D017239:Paclitaxel / Q000008:administration & dosage*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D017239:Paclitaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab