title: Gemcitabine and carboplatin for pretreated metastatic breast cancer: the predictive value of immunohistochemically defined subtypes.
abstract: BACKGROUND
  We evaluated the efficacy of gemcitabine and carboplatin for patients affected by pretreated metastatic breast cancer. A subgroup analysis was performed to evaluate the predictive value of immunohistochemically defined breast cancer subtypes.
  
  
  METHODS
  We included human epidermal growth factor 2 (HER-2) negative metastatic breast cancer resistant to previous anthracycline-based and taxane-based chemotherapy, and HER-2 positive metastatic breast cancer with at least two progressions of disease during protracted trastuzumab-based therapy. Treatment consisted of gemcitabine (1000 mg/m(2) intravenous (iv) on days 1 and 8) and carboplatin (area under the curve 5 iv on day 1) applied every 3 weeks.
  
  
  RESULTS
  Forty-two patients were registered. Disease control was 58%, with a median time-to-progression (TTP) of 7 months (range 1-12) and a median overall survival of 10.5 months (range 1-34). Patients were grouped as triple negative (ER and PR negative, HER-2 negative), HER-2 (HER-2 positive, ER and PR negative), luminal B (ER and/or PR positive and either HER-2 positive and/or high Ki67), and luminal A (ER and/or PR positive and HER-2 negative and low Ki67). For luminal A patients, disease control was lower (luminal A 34 vs. others 67%; P = 0.02), TTP was shorter (luminal A 2.4 months vs. others 6.3 months, P = 0.015), and overall survival was shorter (luminal A 7.5 months vs. others 11.7 months, P = 0.034) than for other subtypes.
  
  
  CONCLUSIONS
  Gemcitabine and carboplatin are effective for pretreated patients with metastatic breast cancer. Luminal A subtype seems to fare poorly compared with other subtypes. Specific difference in gene expression might account for the different outcome.
authors.affiliation: Department of Medical Oncology, Central Hospital of Belcolle, Strada Sammartinese snc, 01100, Viterbo, Italy. f.nelli@asl.vt.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Nelli
authors.forename: Luca
authors.initials: L
authors.lastname: Moscetti
authors.forename: Guido
authors.initials: G
authors.lastname: Natoli
authors.forename: Annalisa
authors.initials: A
authors.lastname: Massari
authors.forename: Giuliana
authors.initials: G
authors.lastname: D'Auria
authors.forename: Mario
authors.initials: M
authors.lastname: Chilelli
authors.forename: Maria Agnese
authors.initials: MA
authors.lastname: Fabbri
authors.forename: Patrizia
authors.initials: P
authors.lastname: Frittelli
authors.forename: Enzo Maria
authors.initials: EM
authors.lastname: Ruggeri
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000473:pathology*; D016190:Carboplatin / Q000008:administration & dosage*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy / Q000473:pathology; D011237:Predictive Value of Tests; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics; D016019:Survival Analysis; D000093542:Gemcitabine
chemical_list: D016190:Carboplatin; D003841:Deoxycytidine; D018719:Erb-b2 Receptor Tyrosine Kinases; D000093542:Gemcitabine; C508053:ERBB2 protein, human