Metronomic oral combination chemotherapy with capecitabine and cyclophosphamide in patients with metastatic breast cancer: A single institution experience

s / The Breast 20 (2011) S12–S55 S47 progression), 48 trastuzumab plus docetaxel (75-100 mg/m2 every 3 weeks for 6-8 cycles), 42 a triple combination of three-weekly trastuzumab plus oral vinorelbine (60mg/m2 days 1 and 8 q 21) and capecitabine (1000 mg/m2 bid days 1->14, every 3 weeks). Response rate (RR) was 76% in trastuzumab+vinorelbine group, 68% in the docetaxel-based regimen and 72% in the triple combination. More treatment-related grade 3-4 toxicities were recorded in the docetaxel-treated population. Median follow-up was 41.2 months, median duration of trastuzumab-based therapy was 18.2 months. Following disease progression, all women continued trastuzumab-based CT as second-line or subsequent lines of treatment, shifting the chemotherapeutic partner, according to our institution policy: 142 as 2nd line treatment, 69 as 3rd , 48 as 4th and 16 as 5th. There was no significant difference in median TTP according to 1st-line treatment type (14, 11 and 12 months, respectively, p1⁄40.62), while a slow decline was observed throughout the successive CT lines, with almost stable values beyond the 3rd (7.5 e 7.2, respectively). Median OS from the start of trastuzumab therapywas 36, 32 and 34months, respectively, in the 3 treatment group (p1⁄40.48). In multivariate analysis the number of trastuzumab-based regimens was significantly correlated to OS (p1⁄40.02), while no correlation was found between the survival benefit and the different type of CT. Conclusions: Our results confirm that the benefit of continuing trastuzumab beyond progression was independent from the CT partner, also suggesting a benefit in overall clinical outcome for given subsequent lines of trastuzumab-based therapy at the time of disease relapse.