title: Clinical outcomes in patients who received lapatinib plus capecitabine combination therapy for HER2-positive breast cancer with brain metastasis and a comparison of survival with those who received trastuzumab-based therapy: a study by the Anatolian Society of Medical Oncology.
abstract: OBJECTIVE
  In this study, we investigated the effect of lapatinib plus capecitabine treatment in HER2-positive breast cancer patients with brain metastasis.
  
  
  METHODS
  Of 405 metastatic breast cancer patients with brain metastases at referral centers in Turkey, 46 were treated with lapatinib plus capecitabine only after the development of brain metastasis. Patients who only received trastuzumab-based therapy after the development of brain metastases were accepted as the historic control group for survival analyses (n = 65). Patients who received both drugs consecutively or sequentially were excluded from the analyses (n = 34).
  
  
  RESULTS
  Median age among 46 patients who received lapatinib plus capecitabine therapy was 45 years (27-76), and median time for development of brain metastases was 11.9 months (0-69 months). Twenty-six out of 38 patients who received lapatinib plus capecitabine and had extracranial metastasis showed partial response or stable diseases (68.4 %). Grade 3-4 toxicity was observed in eight patients (17.3 %). Median overall survival (OS) in patients treated with lapatinib plus capecitabine was significantly increased compared to that in patients treated with trastuzumab-based therapy (19.1 vs. 12 months, respectively, p = 0.039). The incidence of cerebral death was slightly decreased in patients who received lapatinib plus capecitabine compared to those who received trastuzumab-based therapy (32 vs. 43.4 %, p = 0.332). In the multivariate analysis, lapatinib plus capecitabine therapy remained an independent positive predictor for survival [odds ratio (OR), 0.57; p = 0.02].
  
  
  CONCLUSIONS
  Although this retrospective multicenter study had several limitations, the results suggest that undergoing lapatinib plus capecitabine therapy after the diagnosis of brain metastasis may further improve survival compared to undergoing only trastuzumab-based therapy.
authors: Department of Medical Oncology, Dicle University School of Medicine, 21280, Diyarbakir, Turkey, drmalikaplan@hotmail.com.
authors: Muhammet Ali
authors: MA
authors: Kaplan
authors: Abdurrahman
authors: A
authors: Isikdogan
authors: Doğan
authors: D
authors: Koca
authors: Mehmet
authors: M
authors: Kucukoner
authors: Ozge
authors: O
authors: Gumusay
authors: Ramazan
authors: R
authors: Yildiz
authors: Adem
authors: A
authors: Dayan
authors: Lütfiye
authors: L
authors: Demir
authors: Caglayan
authors: C
authors: Geredeli
authors: Murat
authors: M
authors: Kocer
authors: Ulku Yalcintas
authors: UY
authors: Arslan
authors: Ali
authors: A
authors: Inal
authors: Tulay
authors: T
authors: Akman
authors: Ugur
authors: U
authors: Coskun
authors: Nur
authors: N
authors: Sener
authors: Mevlude
authors: M
authors: Inanc
authors: Emin Tamer
authors: ET
authors: Elkiran
authors: Nuriye Yildirim
authors: NY
authors: Ozdemir
authors: Ayse Gok
authors: AG
authors: Durnalı
authors: Ali
authors: A
authors: Suner
authors: Suleyman
authors: S
authors: Alici
authors: Mustafa Oktay
authors: MO
authors: Tarhan
authors: Cem
authors: C
authors: Boruban
authors: Berna
authors: B
authors: Oksuzoglu
authors: Zuhat
authors: Z
authors: Urakci
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D000077341:Lapatinib; D008875:Middle Aged; D011799:Quinazolines / Q000008:administration & dosage; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012189:Retrospective Studies; D016019:Survival Analysis; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069287:Capecitabine; D003841:Deoxycytidine; D005472:Fluorouracil; D000077341:Lapatinib; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human