title: Treatment of HER2 positive advanced breast cancer with T-DM1: A review of the literature.
abstract: BACKGROUND
  Trastuzumab emtansine (T-DM1), a new agent developed for the treatment of HER2-positive breast cancer, is an antibody-drug conjugate with a complex compound obtained by the conjugation of trastuzumab, a stable thioether linker, and the potent cytotoxic drug maytansine-derivate(DM1), which inhibits cell division and induces cell death.
  PubMed database, ESMO, ASCO, San Antonio Breast Cancer Symposium Meeting abstracts and clinicaltrials.gov were searched using the terms "Anti-HER2 treatment breast cancer and trastuzumab emtansine (T-DM1) "; papers considered relevant for the aim of this review were selected.
  
  
  RESULTS
  The phase I trials have determined the safe dosing range of T-DM1, established at 3.6 mg/kg every 3 weeks. The phase III randomized EMILIA and TR3RESA trials have shown that T-DM1 provides objective tumor responses and significantly improves progression free survival and overall survival in HER2-positive metastatic breast cancer patients previously treated with anti-HER2-based regimens. The ongoing phase III trials KAITLIN and KATHERINE will give us further information about the place T-DM1 should occupy in the treatment of patients with early stage HER2-positive breast cancer. In this review we analyze the most relevant clinical trials conducted with T-DM1 and the role of this compound in the management of advanced breast cancer.
  
  
  CONCLUSIONS
  T-DM1 has shown clinically relevant activity in the treatment of HER2-positive breast cancer patients after progression on trastuzumab and taxane based therapy, both in the second line treatment setting and after early relapse on adjuvant trastuzumab therapy. This is accompanied by a favorable safety and tolerability profile.
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, "Rio Hortega Project in research training" (CM12/00264), Spain. Electronic address: maitemartinez3@yahoo.es.
authors: María Teresa
authors: MT
authors: Martínez
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
authors: José Alejandro
authors: JA
authors: Pérez-Fidalgo
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
authors: Paloma
authors: P
authors: Martín-Martorell
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
authors: Juan Miguel
authors: JM
authors: Cejalvo
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
authors: Vanesa
authors: V
authors: Pons
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain.
authors: Begoña
authors: B
authors: Bermejo
authors: Dept. of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Miguel
authors: M
authors: Martín
authors: Dept. of Medical Oncology, Hospital Del Mar, Barcelona, Spain.
authors: Joan
authors: J
authors: Albanell
authors: Dept. of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Spain. Electronic address: lluch_ana@gva.es.
authors: Ana
authors: A
authors: Lluch
mesh_terms: D000080044:Ado-Trastuzumab Emtansine; D061067:Antibodies, Monoclonal, Humanized / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D018450:Disease Progression; D005260:Female; D006801:Humans; D008453:Maytansine / Q000031:analogs & derivatives* / Q000737:chemistry / Q000493:pharmacokinetics / Q000627:therapeutic use; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000378:metabolism; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D000068878:Trastuzumab
chemical_list: D000080044:Ado-Trastuzumab Emtansine; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D008453:Maytansine; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab
keywords: Advanced Breast cancer; Her2 positive; Trastuzumab emtansine; Treatment