Lapatinib-plus-Pegylated Liposomal Doxorubicin in Advanced HER2-positive Breast Cancer Following Trastuzumab. A Phase II Trial

Background: Trastuzumab, one important treatment option for HER2-positive metastatic breast cancer (MBC) is limited by its cardiotoxic potential. Lapatinib and pegylated liposomal doxorubicin (PLD) represent a cardiosparing alternative that can cross the blood brain barrier. This is important, because one third of breast cancer patients develop brain metastases. Patients and Methods: We included 24 patients with HER2-positive MBC progressing under trastuzumab. They received 1,250 mg lapatinib daily until progression plus PLD (40 mg/m(2)) every 4 weeks for maximal 6 cycles. The primary end-point was the overall response rate (ORR). Secondary end-points were progression-free survival (PFS), overall survival (OS), 1-year PFS and 1-year OS rates. Results: ORR was 54%. Median PFS was 5.8 and median OS 233 months. The one-year PFS rate was 27% and 1-year OS rate 76%. Conclusion: Lapatinib-plus-PLD is active and safe in HER2- positive MBC, especially suitable for patients with cardiological risk or brain metastases.