Trastuzumab with either docetaxel or vinorelbine as first-line treatment for patients with HER2-positive advanced breast cancer: a retrospective comparison

From a multi-institutional database we retrieved 179 patients treated with either docetaxel or vinorelbine plus trastuzumab as first-line therapy for HER2-positive advanced breast cancer.Docetaxel-trastuzumab was superior to vinorelbine-trastuzumab in terms of response rate (RR: 77 vs 57%, p = 0.01) and median overall survival (OS: 35 vs 23 months, p = 0.04), but not in median time to progression (TTP: 12 vs 10 months, p = 0.53). At multivariate analysis, type of treatment was not associated with TTP but was an independent predictor of OS, with a significant reduction in the risk of death in favor of docetaxel-trastuzumab (HR 0.474, 95% IC 0,303-0.742, p < 0.01).Docetaxel or vinorelbine, when combined with trastuzumab, provide excellent rates of tumor control in patients with previously untreated HER2-positive advanced breast cancer. Docetaxel may offer some advantage in terms of response rate and resulted in a significantly prolonged overall survival, which, because of the retrospective design of our study, deserves further investigation in prospective trials.Trastuzumab, a monoclonal antibody directed against HER2, the product of the c-erbB2 proto-oncogene, represents a major step forward in the treatment of the subset of 20 to 30% human breast cancers carrying this genetic abnormality[1-4]. The combination of trastuzumab and chemotherapy resulted in improved clinical outcomes, compared with chemotherapy alone, in patients with HER2-positive advanced breast cancer[1,2]. On account of the pivotal trial[1] and of a subsequent randomized phase II study (M77001)[2], this monoclonal antibody was registered for the treatment of HER2-positive advanced breast cancer patients in combination with the taxanes paclitaxel and docetaxel.Based on preclinical observations suggesting additivity or even synergism between trastuzumab and other commonly used cytotoxic agents[5,6], several phase II clinical trials have been subsequently conducted testing different associations. Vinore