Currently, there are no data available on the best choice of treatment in heavily pretreated patients with advanced breast cancer. However, the combination of oral vinorelbine and capecitabine has been demonstrated to be effective and safe in patients with advanced breast cancer pretreated with anthracycline. Furthermore, some studies assessed the activity of dasatinib, an oral tyrosine kinase inhibitor that inhibits five oncogenic tyrosine kinase families, alone or in combination with different chemotherapy in patients affected with advanced breast cancer.
A patient with metastatic breast cancer, hormone receptor positive and human epidermal grow factor receptor 2 negative, pretreated with epirubicine, taxanes and nab-paclitaxel, was submitted to third line chemotherapy with vinorelbine 60 mg/m2 on day 1, 8 plus capecitabine 1000 mg/m2 twice daily from day 1 to day 14 every 21 days. The patient was taking also dasatinib 100 mg once daily for chronic myeloid leukemia. The treatment was well tolerated and, after 15 months, computed tomography scan showed a complete response of liver metastases and bone stable disease. After another 28 months, a 18-fluorodeoxyglucose positron emission tomography scan showed a metabolic response of bone metastases without other site of disease.
This is the first case in literature about activity of dasatinib in combination with a chemotherapy schedule of oral vinorelbine and capecitabine in advanced breast cancer. This treatment showed both good tolerability and great activity with a long progression free survival of 54 months.
Howlader N, et al. SEER cancer statistic review 1975–2014, National Cancer Institute; 2017.
Cortes J, O’Shaughnessy J, Loesch D, Blum JL, Vahdat LT, Petrakova K, et al. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. EMBRACE (Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus E7389) investigators. Lancet. 2011;377(9769):914–23. https://doi.org/10.1016/S0140-6736(11)60070-6 (Epub 2011 Mar 2). CrossRefPubMed
Cazzaniga ME, Cortesi L, Ferzi A, Scaltriti L, Cicchiello F, Ciccarese M, VICTOR Study Group, et al. Metronomic chemotherapy with oral vinorelbine (mVNR) and capecitabine (mCAPE) in advanced HER2-negative breast cancer patients: is it a way to optimize disease control? Final results of the VICTOR-2 study. Breast Cancer Res Treat. 2016;160:501–9. CrossRefPubMedPubMedCentral
Cazzaniga ME, Torri V, Villa F, Giuntini N, Riva F, Zeppellini A, et al. Efficacy and safety of the all-oral schedule of metronomic vinorelbine and capecitabine in locally advanced or metastatic breast cancer patients: the phase I-II VICTOR-1 Study. Int J Breast cancer. 2014;2014:769790. CrossRefPubMedPubMedCentral
Finek J, Holubec L Jr, Svoboda T, Sefrhansova L, Pavlikova I, Votavova M, et al. A phase II trial of oral vinorelbine and capecitabine in anthracycline pretreated patients with metastatic breast cancer. Anticancer Res. 2009;29(2):667–70. PubMed
Jones A, O’Brien M, Sommer H, Nowara E, Welt A, Pienkowski T, et al. Phase II study of oral vinorelbine in combination with capecitabine as second line chemotherapy in metastatic breast cancer patients previously treated with anthracyclines and taxanes. Cancer Chemother Pharmacol. 2010;65(4):755–63. https://doi.org/10.1007/s00280-009-1081-y (Epub 2009 Aug 9). CrossRefPubMed
Pusztai L, Moulder S, Altan M, Kwiatkowski D, Valero V, Ueno NT, et al. Gene signature-guided dasatinib therapy in metastatic breast cancer. Clin Cancer Res. 2014;20(20):5265–71. https://doi.org/10.1158/1078-0432.CCR-14-0800 (Epub 2014 Aug 29). CrossRefPubMed
Zhang XH, Wang Q, Gerald W, Hudis CA, Norton L, Smid M, et al. Latent bone metastasis in breast cancer tied to Src-dependent survival signals. Cancer Cell. 2009;16(1):67–78. https://doi.org/10.1016/j.ccr.2009.05.017. CrossRefPubMedPubMedCentral
Araujo J, Logothetis C. Targeting SRC signaling in metastatic bone disease. Int J Cancer. 2008;124:1–6. CrossRef
Myoui A, Nishimura R, Williams PJ, et al. C-SRC tyrosine kinase activity is associated with tumor colonization in bone and lung in an animal model of human breast cancer metastasis. Cancer Res. 2003;63:5028–33. PubMed
Schott AF, Barlow WE, Van Poznak CH, Hayes DF, Moinpour CM, Lew DL, et al. Phase II studies of two different schedules of dasatinib in bone metastasis predominant metastatic breast cancer: SWOG S0622. Breast Cancer Res Treat. 2016;159(1):87–95. https://doi.org/10.1007/s10549-016-3911-z (Epub 2016 Jul 30). CrossRefPubMedPubMedCentral
Mayer EL, Baurain JF, Sparano J, Strauss L, Campone M, Fumoleau P, et al. A phase 2 trial of dasatinib in patients with advanced HER2-positive and/or hormone receptor-positive breast cancer. Clin Cancer Res. 2011;17(21):6897–904. https://doi.org/10.1158/1078-0432.CCR-11-0070 (Epub 2011 Sep 8). CrossRefPubMed
Somlo G, Atzori F, Strauss LC, Geese WJ, Specht JM, Gradishar WJ, et al. Dasatinib plus capecitabine for advanced breast cancer: safety and efficacy in phase I study CA180004. Clin Cancer Res. 2013;19(7):1884–93. https://doi.org/10.1158/1078-0432.ccr-12-0652 (Epub 2013 Feb 12). CrossRefPubMed
- Complete response in advanced breast cancer patient treated with a combination of capecitabine, oral vinorelbine and dasatinib
- BioMed Central
Neu im Fachgebiet Onkologie
Mail Icon II