Combining two chemotherapy drugs with Trastuzumab ( Herceptin ) to treat women who have metastatic HER2+ breast cancer may offer physicians another choice in their treatment options.

Researchers at Mayo Clinic in Florida have reported that using a combination of Capecitabine, Vinorelbine, and Trastuzumab offers a treatment option that is at least as beneficial as other current options – and doesn't cause hair loss in patients.

The clinical trial is the first in the United States to study this particular combination of therapies in patients with HER2+ metastatic breast cancer. The chemotherapy regimen was previously tested in Europe and demonstrated good anti-tumor activity and low toxicity, so Mayo researchers combined it with Trastuzumab.

Sixty-seven percent of the 45 patients in this trial responded to treatment, with their tumors decreasing in size by at least 30 percent. Historic response to conventional drug regimens ( one chemotherapy drug with Trastuzumab ) that are currently used to treat metastatic HER2+ breast cancer is about 50 percent.

The drug combination used most commonly for patients with HER2+ breast cancer that has spread – Paclitaxel or Docetaxel with trastuzumab – always causes hair loss.

Capecitabine chemotherapy is not usually paired with Trastuzumab because some studies had suggested it does not offer a synergistic, or additive, benefit. However, newer research has shown the combination is in fact promising.

Among the patients studied, 28 ( 58% ) had a partial response, a reduction in the size of the metastatic tumor of more than 30 percent by computed tomography. Four patients had a complete response with no more evidence of metastasized tumors on diagnostic scans.

Average survival was improved when compared historically to traditional treatment. Normally, survival for metastatic breast cancer is two years. In this study, average survival was 27 months.

The toxicity was tolerable, no more than is seen with a two-drug regimen. The majority of patients ( 61% ) experienced a low white blood count, but only about ten percent of patients had fatigue or other common side effects.

This regimen does not offer curative treatment, but it offers patients an improved quality of life compared to other commonly used regimens.

Source: Mayo Clinic, 2009

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