Skip to main content
Top
Published in: Cancer Chemotherapy and Pharmacology 5/2006

01-05-2006 | Original Article

Pegylated liposomal doxorubicin in combination with gemcitabine: a phase II study in anthracycline-naïve and anthracycline pretreated metastatic breast cancer patients

Authors: Alessandra Fabi, Gianluigi Ferretti, Paola Papaldo, Nello Salesi, Mariangela Ciccarese, Vito Lorusso, Paolo Carlini, Armando Carpino, Marcella Mottolese, Anna Maria Cianciulli, Diana Giannarelli, Isabella Sperduti, Alessandra Felici, Francesco Cognetti

Published in: Cancer Chemotherapy and Pharmacology | Issue 5/2006

Login to get access

Abstract

Background: The aim of the study was to assess the toxicity profile, activity in terms of response rate, time to progression, overall survival, and quality of life of pegylated liposomal doxorubicin (PLD) and gemcitabine combination in chemo-naïve and pretreated metastatic breast cancer (MBC) women. Methods: Patients were eligible if they had disease progression to prior chemotherapy (anthracycline-including or not) for early breast cancer or MBC. Patients received PLD 25 mg/m2 intravenously on day 1 plus gemcitabine 800 mg/m2 intravenously on days 1 and 8 of each 21-day cycle. Results: Of 50 patients enrolled, 37 had received prior adjuvant chemotherapy (24 with an anthracycline) and 23 prior chemotherapy for metastatic disease (6 with an anthracycline). Two complete responses and 20 partial responses were achieved in 46 assessable patients (overall response rate: 47.8%). Responses were observed in 14 (46.6%) of 30 patients with previous anthracycline exposure. Median response duration was 7 months, median duration of clinical benefit 8 months, time to progression 7 months. At a median follow-up of 10 months, 79.4% patients were alive at 1 year. No neutropenic complication was observed. Non-hematological toxicities were mild. One patient previously treated with an anthracycline developed a transient decrease (26%) in the left ventricular ejection fraction, with cardiac function recovering within 6 months. Conclusion: Because of the non-overlapping toxicity profiles of both PLD and gemcitabine, this combination can be regarded as a reliable therapeutic option for patients who have failed previous treatments, including anthracycline, for MBC.
Literature
1.
go back to reference Perez AT, Domenech GH, Frankel C, Vogel CL (2002) Pegylated liposomal doxorubicin (Doxil) for metastatic breast cancer: the Cancer Research Network, Inc., experience. Cancer Invest 20(Suppl 2):22–29CrossRefPubMed Perez AT, Domenech GH, Frankel C, Vogel CL (2002) Pegylated liposomal doxorubicin (Doxil) for metastatic breast cancer: the Cancer Research Network, Inc., experience. Cancer Invest 20(Suppl 2):22–29CrossRefPubMed
2.
go back to reference Gabizon A, Martin F (1994) Polyethylene glycol-coated (pegylated) liposomal doxorubicin: rationale for use in solid tumours. Drugs 54(Suppl 4):15–21 Gabizon A, Martin F (1994) Polyethylene glycol-coated (pegylated) liposomal doxorubicin: rationale for use in solid tumours. Drugs 54(Suppl 4):15–21
3.
go back to reference Gabizon AA (1994) Liposomal anthracyclines. Hematol Oncol Clin North Am 8:431–450PubMed Gabizon AA (1994) Liposomal anthracyclines. Hematol Oncol Clin North Am 8:431–450PubMed
4.
go back to reference Gabizon A, Martin F (1997) Polyethylene glycol-coated (pegylated) liposomal doxorubicin: rationale for use in solid tumours. Drugs 54(Suppl 4):15–21PubMedCrossRef Gabizon A, Martin F (1997) Polyethylene glycol-coated (pegylated) liposomal doxorubicin: rationale for use in solid tumours. Drugs 54(Suppl 4):15–21PubMedCrossRef
5.
go back to reference O’Brien MER, Wigler N, Inbar M, Rosso R, Grischke E, Santoro A, Catane R, Kieback DG, Tomczak P, Ackland SP, Orlandi F, Mellars L, Alland L, Tendler C (2004) Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYXTM/Doxil®) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol 15:440–449PubMedCrossRef O’Brien MER, Wigler N, Inbar M, Rosso R, Grischke E, Santoro A, Catane R, Kieback DG, Tomczak P, Ackland SP, Orlandi F, Mellars L, Alland L, Tendler C (2004) Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYXTM/Doxil®) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol 15:440–449PubMedCrossRef
6.
go back to reference Keller AM, Mennel RG, Georgoulias VA, Nabholtz JM, Erazo A, Lluch A, Vogel CL, Kaufmann M, von Minckwitz G, Henderson IC, Mellars L, Alland L, Tendler C (2004) Randomized phase III trial of pegylated liposomal doxorubicin versus vinorelbine or mitomycin C plus vinblastine in women with taxane-refractory advanced breast cancer. J Clin Oncol 22(19):3893–3901CrossRefPubMed Keller AM, Mennel RG, Georgoulias VA, Nabholtz JM, Erazo A, Lluch A, Vogel CL, Kaufmann M, von Minckwitz G, Henderson IC, Mellars L, Alland L, Tendler C (2004) Randomized phase III trial of pegylated liposomal doxorubicin versus vinorelbine or mitomycin C plus vinblastine in women with taxane-refractory advanced breast cancer. J Clin Oncol 22(19):3893–3901CrossRefPubMed
7.
go back to reference Possinger K, Kaufman M, Coleman R et al (1999) Phase II study of gemcitabine as first-line chemotherapy in patients with advanced or metastatic breast cancer. Anti-Cancer Drugs 10:155–162PubMedCrossRef Possinger K, Kaufman M, Coleman R et al (1999) Phase II study of gemcitabine as first-line chemotherapy in patients with advanced or metastatic breast cancer. Anti-Cancer Drugs 10:155–162PubMedCrossRef
8.
go back to reference Carmichael J, Possinger K, Philip P et al (1995) Advanced breast cancer: a phase II trial with gemcitabine. J Clin Oncol 13:2731–2736PubMed Carmichael J, Possinger K, Philip P et al (1995) Advanced breast cancer: a phase II trial with gemcitabine. J Clin Oncol 13:2731–2736PubMed
9.
go back to reference Blackstein M, Vogel CL, Ambinder R et al (1997) Phase II study of gemcitabine in patients with metastatic breast cancer. Eur J Cancer 33, S149 (abs 664) Blackstein M, Vogel CL, Ambinder R et al (1997) Phase II study of gemcitabine in patients with metastatic breast cancer. Eur J Cancer 33, S149 (abs 664)
10.
go back to reference Spielman M, Kalla S, Llombart-Cussac A et al (1997) Activity of gemcitabine in metastatic breast cancer patients previously treated with anthracycline-containing regimens. Eur J Cancer 33:S149 (abs 663) Spielman M, Kalla S, Llombart-Cussac A et al (1997) Activity of gemcitabine in metastatic breast cancer patients previously treated with anthracycline-containing regimens. Eur J Cancer 33:S149 (abs 663)
11.
go back to reference Rivera E (2003) Liposomal anthracyclines in metastatic breast cancer: clinical update. Oncologist 8(Suppl 2):3–9CrossRefPubMed Rivera E (2003) Liposomal anthracyclines in metastatic breast cancer: clinical update. Oncologist 8(Suppl 2):3–9CrossRefPubMed
12.
go back to reference Rivera E, Valero V, Syrewicz L, Rahman Z, Esteva FJ, Theriault RL, Rosales MM, Booser D, Murray JL, Bast RC Jr, Hortobagyi GN (2001) Phase I study of stealth liposomal doxorubicin in combination with gemcitabine in the treatment of patients with metastatic breast cancer. J Clin Oncol 19(6):1716–1722PubMed Rivera E, Valero V, Syrewicz L, Rahman Z, Esteva FJ, Theriault RL, Rosales MM, Booser D, Murray JL, Bast RC Jr, Hortobagyi GN (2001) Phase I study of stealth liposomal doxorubicin in combination with gemcitabine in the treatment of patients with metastatic breast cancer. J Clin Oncol 19(6):1716–1722PubMed
13.
go back to reference Rivera E, Valero V, Arun B, Royce M, Adinin R, Hoelzer K, Walters R, Wade JL 3rd, Pusztai L, Hortobagyi GN (2003) Phase II study of pegylated liposomal doxorubicin in combination with gemcitabine in patients with metastatic breast cancer. J Clin Oncol 21(17):3249–3254CrossRefPubMed Rivera E, Valero V, Arun B, Royce M, Adinin R, Hoelzer K, Walters R, Wade JL 3rd, Pusztai L, Hortobagyi GN (2003) Phase II study of pegylated liposomal doxorubicin in combination with gemcitabine in patients with metastatic breast cancer. J Clin Oncol 21(17):3249–3254CrossRefPubMed
14.
go back to reference Miller AB, Hoogstraten B, Staquet M et al (1981) Reporting results of cancer treatment. Cancer 47:207–214PubMedCrossRef Miller AB, Hoogstraten B, Staquet M et al (1981) Reporting results of cancer treatment. Cancer 47:207–214PubMedCrossRef
15.
go back to reference Hryniuk WM, Goodyear M (1990) The calculation of received dose intensity. J Clin Oncol 8(12):1935–1937PubMed Hryniuk WM, Goodyear M (1990) The calculation of received dose intensity. J Clin Oncol 8(12):1935–1937PubMed
16.
go back to reference Fabi A, Ferretti G, Salesi N, Papaldo P, Carlini P, Ciccarese M, Di Cocco B, Cecere F, Nardoni C, Felici A, Cognetti F (2005) Can HER2 overexpression predict response to pegylated liposomal doxorubicin in metastatic breast cancer patients? Ann Oncol 16(3):516–517CrossRefPubMed Fabi A, Ferretti G, Salesi N, Papaldo P, Carlini P, Ciccarese M, Di Cocco B, Cecere F, Nardoni C, Felici A, Cognetti F (2005) Can HER2 overexpression predict response to pegylated liposomal doxorubicin in metastatic breast cancer patients? Ann Oncol 16(3):516–517CrossRefPubMed
17.
go back to reference Theodoulou M, Hudis C (2004) Cardiac profiles of liposomal anthracyclines: greater cardiac safety versus conventional doxorubicin? Cancer 100(10):2052–2063CrossRefPubMed Theodoulou M, Hudis C (2004) Cardiac profiles of liposomal anthracyclines: greater cardiac safety versus conventional doxorubicin? Cancer 100(10):2052–2063CrossRefPubMed
18.
go back to reference Gabizon AA, Lyass O, Berry GJ, Wildgust M (2004) Cardiac safety of pegylated liposomal doxorubicin (Doxil/Caelyx) demonstrated by endomyocardial biopsy in patients with advanced malignancies.Cancer Invest 22(5):663–669CrossRefPubMed Gabizon AA, Lyass O, Berry GJ, Wildgust M (2004) Cardiac safety of pegylated liposomal doxorubicin (Doxil/Caelyx) demonstrated by endomyocardial biopsy in patients with advanced malignancies.Cancer Invest 22(5):663–669CrossRefPubMed
19.
go back to reference Wigler N, O’Brien M, Rosso R et al (2002) Reduced cardiac toxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin (CAELYXTM/Doxil) vs. doxorubicin for first-line treatment of metastatic breast cancer. Proc Am Soc Clin Oncol 21:45a (abstr 177) Wigler N, O’Brien M, Rosso R et al (2002) Reduced cardiac toxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin (CAELYXTM/Doxil) vs. doxorubicin for first-line treatment of metastatic breast cancer. Proc Am Soc Clin Oncol 21:45a (abstr 177)
20.
go back to reference Safra T, Muggia F, Jeffers S et al (2000) Pegylated liposomal doxorubicin (Doxil): reduced clinical cardiotoxicity in patients reaching or exceeding cumulative doses of 500 mg/m2. Ann Oncol 11:1029–1033CrossRefPubMed Safra T, Muggia F, Jeffers S et al (2000) Pegylated liposomal doxorubicin (Doxil): reduced clinical cardiotoxicity in patients reaching or exceeding cumulative doses of 500 mg/m2. Ann Oncol 11:1029–1033CrossRefPubMed
21.
go back to reference Berry G, Billingham M, Alderman E et al (1998) The use of cardiac biopsy to demonstrate reduced cardiotoxicity in AIDS Kaposi’s sarcoma patients treated with pegylated liposomal doxorubicin. Ann Oncol 9:711–716CrossRefPubMed Berry G, Billingham M, Alderman E et al (1998) The use of cardiac biopsy to demonstrate reduced cardiotoxicity in AIDS Kaposi’s sarcoma patients treated with pegylated liposomal doxorubicin. Ann Oncol 9:711–716CrossRefPubMed
22.
go back to reference Mass R (2000) The role of HER-2 expression in predicting response to therapy in breast cancer. Semin Oncol 27(6 Suppl 11):46–52PubMed Mass R (2000) The role of HER-2 expression in predicting response to therapy in breast cancer. Semin Oncol 27(6 Suppl 11):46–52PubMed
23.
go back to reference Muss HB, Thor AD, Berry DA et al (1994) c-erbB-2 expression and response to adjuvant therapy in women with node-positive early breast cancer. N Engl J Med 5:330(18):1260–1266 Muss HB, Thor AD, Berry DA et al (1994) c-erbB-2 expression and response to adjuvant therapy in women with node-positive early breast cancer. N Engl J Med 5:330(18):1260–1266
24.
go back to reference Zhang F, Yang Y, Smith T et al (2003) Correlation between HER-2 expression and response to neoadjuvant chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide in patients with breast carcinoma. Cancer 97(7):1758–1765CrossRefPubMed Zhang F, Yang Y, Smith T et al (2003) Correlation between HER-2 expression and response to neoadjuvant chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide in patients with breast carcinoma. Cancer 97(7):1758–1765CrossRefPubMed
25.
go back to reference Moliterni A, Menard S, Valagussa P et al (2003) HER2 overexpression and doxorubicin in adjuvant chemotherapy for resectable breast cancer. J Clin Oncol 21(3):458–462CrossRefPubMed Moliterni A, Menard S, Valagussa P et al (2003) HER2 overexpression and doxorubicin in adjuvant chemotherapy for resectable breast cancer. J Clin Oncol 21(3):458–462CrossRefPubMed
26.
go back to reference Petit T, Borel C, Ghnassia JP et al (2001) Chemotherapy response of breast cancer depends on HER-2 status and anthracycline dose intensity in the neoadjuvant setting. Clin Cancer Res 7(6):1577–1581PubMed Petit T, Borel C, Ghnassia JP et al (2001) Chemotherapy response of breast cancer depends on HER-2 status and anthracycline dose intensity in the neoadjuvant setting. Clin Cancer Res 7(6):1577–1581PubMed
27.
go back to reference Pegram MD, Finn RS, Arzoo K et al (1997) The effect of HER-2/neu overexpression on chemotherapeutic drug sensitivity in human breast and ovarian cancers cells. Oncogene 15:537–547CrossRefPubMed Pegram MD, Finn RS, Arzoo K et al (1997) The effect of HER-2/neu overexpression on chemotherapeutic drug sensitivity in human breast and ovarian cancers cells. Oncogene 15:537–547CrossRefPubMed
28.
go back to reference Sledge GW (2001) Is HER-2/neu a predictor of anthracycline utility? No. J Natl Cancer Inst Monogr 30:85–87PubMed Sledge GW (2001) Is HER-2/neu a predictor of anthracycline utility? No. J Natl Cancer Inst Monogr 30:85–87PubMed
29.
go back to reference Paik S, Bryant J, Park C et al (1998) erbB-2 and response to doxorubicin in patients with axillary lymph node-positive, hormone receptor-negative breast cancer. J Natl Cancer Inst 90:1361–1370CrossRefPubMed Paik S, Bryant J, Park C et al (1998) erbB-2 and response to doxorubicin in patients with axillary lymph node-positive, hormone receptor-negative breast cancer. J Natl Cancer Inst 90:1361–1370CrossRefPubMed
30.
go back to reference Thor AD, Berry DA, Budman DR et al (1998) erbB-2, p53, and efficacy of adjuvant therapy in lymph node-positive breast cancer. J Natl Cancer Inst 90:1346–1360CrossRefPubMed Thor AD, Berry DA, Budman DR et al (1998) erbB-2, p53, and efficacy of adjuvant therapy in lymph node-positive breast cancer. J Natl Cancer Inst 90:1346–1360CrossRefPubMed
31.
go back to reference Ravdin P, Green S, Albain K et al (1998) Initial report of the SWOG biological correlative study of c-erbB-2 expression as a predictor of outcome in a trial comparing adjuvant CAF T with tamoxifen (T) alone [abstract]. Proc ASCO 17:97 Ravdin P, Green S, Albain K et al (1998) Initial report of the SWOG biological correlative study of c-erbB-2 expression as a predictor of outcome in a trial comparing adjuvant CAF T with tamoxifen (T) alone [abstract]. Proc ASCO 17:97
32.
go back to reference Dressler L, Berry D, Liu E et al (1999) Amplification of erbB2 by fluorescent in situ hybridization (FISH): an alternate method to predict outcome following dose-escalated CAF in stage II, node positive breast cancer patients. A Cancer and Leukemia Group B (CALGB) study [abstract]. Proc ASCO 18:75 Dressler L, Berry D, Liu E et al (1999) Amplification of erbB2 by fluorescent in situ hybridization (FISH): an alternate method to predict outcome following dose-escalated CAF in stage II, node positive breast cancer patients. A Cancer and Leukemia Group B (CALGB) study [abstract]. Proc ASCO 18:75
33.
go back to reference Ranson MR, Carmichael J, O’Byrne K et al (1997) Treatment of advanced breast cancer with sterically stabilized liposomal doxorubicin: Results of a multicenter phase II trial. J Clin Oncol 15:3185–3191PubMed Ranson MR, Carmichael J, O’Byrne K et al (1997) Treatment of advanced breast cancer with sterically stabilized liposomal doxorubicin: Results of a multicenter phase II trial. J Clin Oncol 15:3185–3191PubMed
34.
go back to reference Lyass O, Uziely B, Ben-Yosef R et al (2000) Correlation of toxicity with pharmacokinetics of pegylated liposomal doxorubicin (Doxil) in metastatic breast carcinoma. Cancer 89:1037–1047CrossRefPubMed Lyass O, Uziely B, Ben-Yosef R et al (2000) Correlation of toxicity with pharmacokinetics of pegylated liposomal doxorubicin (Doxil) in metastatic breast carcinoma. Cancer 89:1037–1047CrossRefPubMed
35.
go back to reference Untch M, Eidtmann H, du Bois A et al (2004) Cardiac safety of trastuzumab in combination with epirubicin and cyclophosphamide in women with metastatic breast cancer: results of a phase I trial. Eur J Cancer 40(7):988–997CrossRefPubMed Untch M, Eidtmann H, du Bois A et al (2004) Cardiac safety of trastuzumab in combination with epirubicin and cyclophosphamide in women with metastatic breast cancer: results of a phase I trial. Eur J Cancer 40(7):988–997CrossRefPubMed
36.
go back to reference Buzdar AU, Ibrahim NK, Francis D et al (2005) Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23(16):3676–3685CrossRefPubMed Buzdar AU, Ibrahim NK, Francis D et al (2005) Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23(16):3676–3685CrossRefPubMed
37.
go back to reference Chia SK, Clemenson M, Martin LA et al (2004) A multicenter phase II trial of pegylated liposomal doxorubicin and trastuzumab in Her-2 over-expressing metastatic breast cancer (MBC). Proc ASCO 23:630 Chia SK, Clemenson M, Martin LA et al (2004) A multicenter phase II trial of pegylated liposomal doxorubicin and trastuzumab in Her-2 over-expressing metastatic breast cancer (MBC). Proc ASCO 23:630
38.
go back to reference Park JW, Benz CC, Martin FJ (2004) Future directions of liposome- and immunoliposome-based cancer therapeutics. Semin Oncol 31(6 Suppl 13):196–205CrossRefPubMed Park JW, Benz CC, Martin FJ (2004) Future directions of liposome- and immunoliposome-based cancer therapeutics. Semin Oncol 31(6 Suppl 13):196–205CrossRefPubMed
39.
go back to reference Haider H, Kornek G, Kwasny W, Depisch D, Payrits T, Scheithauer W, Lang F (2004) Multicenter phase II trial of gemcitabine plus liposomal doxorubicin in chemotherapeutically pretreated patients with advanced breast cancer (ABC). Journal of Clinical Oncology ASCO Annual Meeting Proceedings (Post-Meeting Edition). Vol 22, No 14S (July 15 Supplement): 696 Haider H, Kornek G, Kwasny W, Depisch D, Payrits T, Scheithauer W, Lang F (2004) Multicenter phase II trial of gemcitabine plus liposomal doxorubicin in chemotherapeutically pretreated patients with advanced breast cancer (ABC). Journal of Clinical Oncology ASCO Annual Meeting Proceedings (Post-Meeting Edition). Vol 22, No 14S (July 15 Supplement): 696
40.
go back to reference Wong Z-W, Khoo K-S, Shah VA et al (2002) Phase I/II study of pegylated liposomal doxorubicin (PLD) and gemcitabine (G) as first-line therapy for metastatic breast cancer (MBC). Proc Am Soc Clin Oncol 21:49b (abstr 2008) Wong Z-W, Khoo K-S, Shah VA et al (2002) Phase I/II study of pegylated liposomal doxorubicin (PLD) and gemcitabine (G) as first-line therapy for metastatic breast cancer (MBC). Proc Am Soc Clin Oncol 21:49b (abstr 2008)
Metadata
Title
Pegylated liposomal doxorubicin in combination with gemcitabine: a phase II study in anthracycline-naïve and anthracycline pretreated metastatic breast cancer patients
Authors
Alessandra Fabi
Gianluigi Ferretti
Paola Papaldo
Nello Salesi
Mariangela Ciccarese
Vito Lorusso
Paolo Carlini
Armando Carpino
Marcella Mottolese
Anna Maria Cianciulli
Diana Giannarelli
Isabella Sperduti
Alessandra Felici
Francesco Cognetti
Publication date
01-05-2006
Publisher
Springer-Verlag
Published in
Cancer Chemotherapy and Pharmacology / Issue 5/2006
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-005-0116-2

Other articles of this Issue 5/2006

Cancer Chemotherapy and Pharmacology 5/2006 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine