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Journal of Clinical Oncology, Vol 19, Issue 10 (May), 2001: 2587-2595
© 2001 American Society for Clinical Oncology


RAPID PUBLICATIONS

Weekly Trastuzumab and Paclitaxel Therapy for Metastatic Breast Cancer With Analysis of Efficacy by HER2 Immunophenotype and Gene Amplification

By Andrew D. Seidman, Monica N. Fornier, Francisco J. Esteva, Lee Tan, Stamatina Kaptain, Ariadne Bach, Katherine S. Panageas, Crispinita Arroyo, Vicente Valero, Violante Currie, Teresa Gilewski, Maria Theodoulou, Mary Ellen Moynahan, Mark Moasser, Nancy Sklarin, Maura Dickler, Gabriella D’Andrea, Massimo Cristofanilli, Edgardo Rivera, Gabriel N. Hortobagyi, Larry Norton, Clifford A. Hudis

From the Breast Cancer Medicine Service, Department of Pathology, Department of Radiology, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY; and Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Andrew D. Seidman, MD, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; email: seidmana{at}mskcc.org

PURPOSE: This phase II study evaluated weekly trastuzumab and paclitaxel therapy in women with HER2-normal and HER2-overexpressing metastatic breast cancer. Efficacy was correlated with immunohistochemical and fluorescent in situ hybridization (FISH) assay results.

PATIENTS AND METHODS: Eligible patients had bidimensionally measurable metastatic breast cancer. Up to three prior chemotherapy regimens, including prior anthracycline and taxane therapy, were allowed. Trastuzumab 4 mg/kg and paclitaxel 90 mg/m2 were administered on week 1, with trastuzumab 2 mg/kg and paclitaxel 90 mg/m2 administered on subsequent weeks. HER2 status was evaluated using four different immunohistochemical assays and FISH.

RESULTS: Patients received a median of 25 weekly infusions (range, one to 85 infusions). Median delivered paclitaxel dose-intensity was 82 mg/m2/wk (range, 52 to 90 mg/m2/wk). The intent-to-treat response rate for all 95 patients enrolled was 56.8% (95% confidence interval, 47% to 67%). A response rate of 61.4% (4.5% complete response, 56.8% partial response) was observed in 88 fully assessable patients. In patients with HER2-overexpressing tumors, overall response rates ranged from 67% to 81% compared with 41% to 46% in patients with HER2-normal expression (ranges reflect the different assay methods used to assess HER2 status). Differences in response rates between patients with HER2-overexpressing tumors and those with normal HER2 expression were statistically significant for all assay methods, with CB11 and TAB250 antibodies and FISH having the strongest significance. Therapy was generally well tolerated, although three patients had serious cardiac complications.

CONCLUSION: Weekly trastuzumab and paclitaxel therapy is active in women with metastatic breast cancer. Therapy was relatively well tolerated; however, attention to cardiac function is necessary.


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Gold-Facilitated in Situ Hybridization : A Bright-Field Autometallographic Alternative to Fluorescence in Situ Hybridization for Detection of HER-2/neu Gene Amplification
Am. J. Pathol., May 1, 2002; 160(5): 1589 - 1595.
[Abstract] [Full Text] [PDF]


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F. J. Esteva, V. Valero, D. Booser, L. T. Guerra, J. L. Murray, L. Pusztai, M. Cristofanilli, B. Arun, B. Esmaeli, H. A. Fritsche, et al.
Phase II Study of Weekly Docetaxel and Trastuzumab for Patients With HER-2-Overexpressing Metastatic Breast Cancer
J. Clin. Oncol., April 1, 2002; 20(7): 1800 - 1808.
[Abstract] [Full Text] [PDF]


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A. Seidman, C. Hudis, M. K. Pierri, S. Shak, V. Paton, M. Ashby, M. Murphy, S. J. Stewart, and D. Keefe
Cardiac Dysfunction in the Trastuzumab Clinical Trials Experience
J. Clin. Oncol., March 1, 2002; 20(5): 1215 - 1221.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
K. J. Savinainen, O. R. Saramaki, M. J. Linja, O. Bratt, T. L. J. Tammela, J. J. Isola, and T. Visakorpi
Expression and Gene Copy Number Analysis of ERBB2 Oncogene in Prostate Cancer
Am. J. Pathol., January 1, 2002; 160(1): 339 - 345.
[Abstract] [Full Text] [PDF]


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The OncologistHome page
R. B. Livingston and F. J. Esteva
Chemotherapy and Herceptin for HER-2+ Metastatic Breast Cancer: The Best Drug?
Oncologist, August 1, 2001; 6(4): 315 - 316.
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