Shawky Hanan, Tawfik Hesham
Clinical Oncology Department, Faculty of Medicine, Tanta University Hospital, Egypt.
Clinical Oncology Department, Faculty of Medicine, Tanta University Hospital, Egypt.
J Egypt Natl Canc Inst. 2014 Dec;26(4):187-94. doi: 10.1016/j.jnci.2014.08.001. Epub 2014 Oct 5.
Approximately one-third of patients with advanced, HER2+ve breast cancer (BC) develop brain metastases (BMs). The aim of this study is to investigate efficacy and tolerability of the combination of lapatinib and capecitabine (LC) in HER2+ve BC patients with brain metastases (BCBM).
Between January 2011 and January 2013, 21 patients with HER2+ve BCBM were included. Sixteen patients (76.19%) progressed after whole brain radiotherapy (WBRT) and 5 patients (23.81%) were treatment-naïve for BM. Patients received lapatinib (1250 mg/day continuously) and capecitabine (2000 mg/m2 on days 1-14 of a 21-day cycle). All patients were treated with trastuzumab either in the adjuvant or metastatic setting. No patients had received prior lapatinib and/or capecitabine. End-points were response rate (RR), progression free survival (PFS), overall survival (OS) and toxicity.
The overall response rate (ORR) was 33.3% (7/21) and all were partial response. For patients receiving prior WBRT and patients receiving LC as first line treatment for BCBM the ORR was 31.2% (5/16) and 40.0% (2/5) respectively. Median PFS was 5.5 months. Median OS was 11 months. Treatment-related adverse events were manageable. Grade 3-4 toxicities were hand-foot syndrome (14.3%), diarrhea (14.3%), nausea/vomiting (9.5%), mucositis (4.8%), and skin rash (4.8%).
The combination of LC is active and well-tolerated treatment in patients with HER2+ve BCBM.
约三分之一的晚期HER2阳性乳腺癌（BC）患者会发生脑转移（BMs）。本研究旨在探讨拉帕替尼与卡培他滨联合用药（LC）对HER2阳性脑转移乳腺癌（BCBM）患者的疗效和耐受性。
2011年1月至2013年1月期间，纳入21例HER2阳性BCBM患者。16例患者（76.19%）在全脑放疗（WBRT）后病情进展，5例患者（23.81%）未接受过BM治疗。患者接受拉帕替尼（持续每日1250 mg）和卡培他滨（21天周期的第1 - 14天，2000 mg/m²）治疗。所有患者在辅助或转移情况下均接受曲妥珠单抗治疗。所有患者均未接受过拉帕替尼和/或卡培他滨治疗。观察终点为缓解率（RR）、无进展生存期（PFS）、总生存期（OS）和毒性。
总缓解率（ORR）为33.3%（7/21），均为部分缓解。对于接受过WBRT的患者和接受LC作为BCBM一线治疗的患者，ORR分别为31.2%（5/16）和40.0%（2/5）。中位PFS为5.5个月。中位OS为11个月。与治疗相关的不良事件可控。3 - 4级毒性反应为手足综合征（14.3%）、腹泻（14.3%）、恶心/呕吐（9.5%）、黏膜炎（4.8%）和皮疹（4.8%）。
LC联合用药对HER2阳性BCBM患者有效且耐受性良好。
