title: Combination chemotherapy with mitomycin C and methotrexate is active against metastatic HER2-negative breast cancer even after treatment with anthracycline, taxane, capecitabine, and vinorelbine.
abstract: BACKGROUND
  Combination chemotherapy with mitomycin C and methotrexate (MM) was reported to be effective for 24% of patients with metastatic breast cancer (MBC) who had been treated with anthracycline and taxane. Antimetabolites such as capecitabine and antitubulins such as vinorelbine have been generally used for MBC treatment after anthracycline and taxane. A subsequent choice of chemotherapy should be offered to patients with MBC who have kept good performance status (PS) after being aggressively treated with anthracycline, taxane, capecitabine, and vinorelbine (ATCV), but is not well clear which treatment is superior to others after ATCV. In this study, we examined whether MM treatment is a good choice following ATCV.
  
  
  METHODS
  We retrospectively reviewed the medical records of 31 patients with HER2-negative metastatic breast cancer who were treated with MM following ATCV. One cycle of MM was defined as MMC 8 mg/m(2) on day 1 and MTX 60 mg/m(2) on day 1 and day 15, administered intravenously every 4 weeks.
  
  
  RESULTS
  Response rate and clinical benefit rate were 9.7 and 19.4%, respectively. Median times to progression and times to failure were 3.9 and 3.7 months, respectively. Adverse events of grade 3 and/or 4 were observed in 36% patients. Thrombocytopenia of grade 3 or 4 was 12.9 and 3.2%. Grades 3 and 4 of leucopenia and anemia were 12.9 and 9.7%, respectively.
  
  
  CONCLUSIONS
  MM is effective and tolerable for MBC patients even after aggressive treatment with ATCV. MM is one treatment choice when patients have kept good PS and bone marrow function even after multiple regimens of chemotherapy.
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan ; Department of Translational Oncology, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa Japan.
authors.forename: Takayo
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan ; Department of Breast Oncology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tanabe
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan.
authors.forename: Kokoro
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan.
authors.forename: Ippei
authors.initials: I
authors.lastname: Fukada
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwase
authors.affiliation: Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
keywords: Anthracycline; Capecitabine; Metastatic breast cancer; Methotrexate; Mitomycin C; Taxane; Vinorelbine