Skip to main content
Log in

Safety and Activity of the Combination of Pegylated Liposomal Doxorubicin and Weekly Docetaxel in Advanced Breast Cancer

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background. The present study was designed with the aim of evaluating the tolerability and activity of pegylated liposomial doxorubicin (PLD) in combination with weekly docetaxel as first line treatment of advanced breast cancer. Patients and methods. Fifty-seven patients entered the study. PLD was administered at escalating doses starting from 30 mg/m, on day 1; docetaxel was administered at the fixed dose of 35 mg/m on days 2 and 9. A cycle of therapy consisted of 21 days. Results. The MTD was achieved at the dose of 40 mg/m of PLD, being febrile neutropenia and palmar-plantar-erythrodisesthesia (PPE) the dose-limiting toxicities (DLTs), so that the fixed dose of PLD for the Phase II study was 35 mg/m. Forty-two consecutive patients received treatment at the established dose for a total of 194 cycles: among these, three patients were withdrawn for severe allergic reaction at the first administration of PLD. Hematological toxicity was moderate, the most common grade 1–3 non-hematological toxicities were stomatitis and PPE, occurring in 20 (47.5%) and 16 (38%) patients, respectively. No cardiac toxicity was recorded. According to the intent to treat analysis a major objective response was observed in 59.5% of patients (95% CI, 43.3–74.4%), with a median time to progression of 9months and an estimated overall survival at 18 months of 62%. Conclusion. The combination of PLD and weekly docetaxel is an effective first-line therapy for patients with advanced breast cancer. PPE and mucositis are the most relevant side effects of such a combination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  1. Greenberg PA, Hortobagyi GN, Smith TL, Ziegler LD, Frye DK, Buzder AU: Long–term follow–up of patients with complete remission following combination chemoterapy for metastatic breast breast cancer. J Clin Oncol 14: 2197–2205, 1996

    PubMed  Google Scholar 

  2. Valero V, Hortobagyi GN: Are anthracycline–taxane regimens the new standard of care in the treatment of metastatic breast cancer? J Clin Oncol 6: 959–962, 2003

    Article  Google Scholar 

  3. Launchbury AP, Habboubi N. Epirubicin and doxorubicin: a comparison of their characteristics, therapeutic activity and toxicity. Cancer Treat Rev 19: 197–206, 1993

    Article  PubMed  Google Scholar 

  4. Gasparini G, Dal Fior S, Panizzoni GA, Favretto S, Pozza F: Weekly epirubicin versus doxorubicin as second–line therapy in advanced breast cancer: a randomized clinical trial. Am J Clin Oncol 14: 38–44, 1991

    PubMed  Google Scholar 

  5. Huang L (ed): Covalentely attached polymers and glycans to alter the biodistribution of liposomes. J Liposome Res 2: 289–454, 1992

    Google Scholar 

  6. Amantea MA, Forrest A, Northfelt DW, Mamelok R: Population pharmacokinetics and pharmacodynamics of pegylated–liposomial doxorubicin in patients with AIDSrelated Kaposi sarcoma. Clin Pharmacol Ther 61: 301–311, 1997

    PubMed  Google Scholar 

  7. Vaage J, Barbera–Guillman E, Abra R, Huang A, Working P: Tissue distribution and therapeutic effect of intravenous free or encapsulated liposomal doxorubicin on human prostate carcinoma xenografts. Cancer 73: 1478–1484, 1994

    PubMed  Google Scholar 

  8. Martin FJ. Pegylated liposomal doxorubicin: scientific rationale and preclinical pharmacology. Oncology 11: 11–20, 1997

    Google Scholar 

  9. Williams SS, Alosco TR, Mayhew E, Lasic DD, Martin FJ, Bankert RB: Arrest of human lung tumor xenograft growth in SCID mice using doxorubicin encapsulated in sterically stabilised liposomes. Cancer Res 53: 3964–3967, 1993

    PubMed  Google Scholar 

  10. Vaage J, Donovan D, Mayhew E, Uster: Therapy of mouse mammary carcinomas with vincristine and doxorubicin encapsulated in sterically stabilized liposomes. Int J Cancer 54: 959–964, 1993

    PubMed  Google Scholar 

  11. Vaage J, Donovan D, Mayhew E, Abra R, Huang A: Therapy of human ovarian carcinoma xenografts using A Morabito et al. 256 doxorubicin encapsulated in sterically stabilized liposomes.Cancer 72: 3671–3675, 1993

    PubMed  Google Scholar 

  12. Northfelt DW, Dezube B, Miler B, et al: Randomized comparative trial of doxil versus adriamycin, bleomycin and vincristine in the treatment of severe AIDS–related Kaposi's sarcoma. Blood 86: 382a [abstr], 1995

  13. Goebel FD, Goldstein D, Goos M, Jablonwski H, Stewart JS: Efficacy and safety of stealth liposomal doxorubicin in AIDS–related Kaposi's sarcoma. Br J Cancer 73: 989–994, 1996

    Google Scholar 

  14. Uziely B, Jeffers S, Isacson R, Kutsch K, Wei–Tsao D, Yehoshua Z, Libson E, Muggia FM, Gabizon M: Liposomal doxorubicin: antitumor activity and unique toxicities during two complementary phase I studies. J Clin Oncol 13: 1777–1785, 1995

    PubMed  Google Scholar 

  15. Ranson MR, Carmichael J, O'Byrne K, Stewarts S, Smith D, Howell A: Treatment of advanced breast cancer with sterically stabilized liposomal doxorubicin: results of a multicenter phase II trial. J Clin Oncol 15: 3185–3191, 1997

    PubMed  Google Scholar 

  16. Fumoleau P, Chevallier B, Kerbrat P, Krakowski Y, Misset JL, Mangard–Louboutin C, Dieras V, Azli N, Bougon N, Riva A, Roche H: A multicentre phase II study of the efficacy and safety of docetaxel as first line treatment of advanced breast cancer: report of the EORTC. Ann Oncol 7: 165–171, 1996

    PubMed  Google Scholar 

  17. Chan S, Friedrichs K, Noel D, Pinter T, Van Belle S, Vorobiof D, Duarte R, Gil Gil M, Bodrogi I, Murray E, Yelle L, von Minckwitz G, Korec S, Simmonds P, Buzzi F, Gonzalez Mancha R, Richardson G, Walpole E, Ronzoni M, Murrawsky M, Alaki M, Riva A: Prospective randomized trial of docetaxel versus doxorubicin in patients with metastatic breast cancer. J Clin Oncol 17: 2341–2354, 1999

    PubMed  Google Scholar 

  18. Crown J: A review of the efficacy and safety of docetaxel as monotherapy in metastatic breast cancer. Semin Oncol (suppl); 26: 5–9, 1999

    Google Scholar 

  19. Tomiak E, Piccart MJ, Kerger J, Lips S, Awada A, de Valeriola D, Ravoet C, Lossignol D, Sculier JP, Anzannet V, et al.: Phase I study of docetaxel administered as a 1–hour intravenous infusion on a weekly basis. J Clin Oncol 12: 1458–1467, 1994

    PubMed  Google Scholar 

  20. Burstein HJ, Manola J, Younger J, Parker LM, Bunnel CA, Scheib R: Docetaxel administered on a weekly basis for metastatic breast cancer. J Clin Oncol 18: 1212–1219, 2000

    PubMed  Google Scholar 

  21. Belotti D, Vergani V, Drudis T, Borsotti P, Pitelli MR, Viale G, Giavazzi R, Taraboletti G: The microtubule affecting drug paclitaxel has antiangiogenic activity. Clin Cancer Res 2: 1843–1849, 1996

    PubMed  Google Scholar 

  22. Gasparini G. The rationale and future potential of angiogenesis inhibitors in neoplasia. Drugs 58: 17–38, 1999.

    Google Scholar 

  23. Gasparini G and Harris AL: Angiogenesis: pathological, prognostic and growth factor pathways and their link to trial design and anticancer drugs. Lancet Oncol 2: 278–289, 2001

    Article  PubMed  Google Scholar 

  24. Misset JL, Dieras V, Gruia G, Bourgeois H, Cvitkovic E, Kalla S, Bozec L, Beuzeboc P, Jans C, Aussel JP, Riva A, Azli N, Pouillart P: Dose–finding study of docetaxel and doxorubicin in first–line treatment of patients with metastatic breast cancer. Ann Oncol 10: 553–560, 1999

    Article  PubMed  Google Scholar 

  25. Nabholtz JM, Falkson C, Campos D, Szanto J, Martin M, Chan S, Pienkowsky T, Zaluski J, Pinten T, Krzakowski M, Vorobiof, Leonard R, Kennedy J, Azli N, Murawsky M, Riva A, Pouillart P: Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first–line chemotherapy for metastatic breast cancer: results of a randomized, multicenter phase III trial. J Clin Oncol 21: 968–975, 2003

    Article  PubMed  Google Scholar 

  26. Caponigro F, Comella P, Budillon A, Bryce J, Avallone A, De Rosa V, Ionna F, Comella G: Phase I study of Caelyx (doxorubicin HCL, pegylated liposomal) in recurrent or metastatic head and neck cancer. Ann Oncol 11: 339–342, 2000

    Article  PubMed  Google Scholar 

  27. Hamilton A, Biganzoli L, Coleman R, Mauriac L, Hennebert P, Awada A, Nooij M, Beex L, Piccart M, Van Hoorebeck I, Bruning P, de Valeriola D: EORTC 10968: a phase I clinical and pharmacokinetic study of polyethylene glycol liposomal doxorubicin (Caelyx, Doxil) at a 6–week interval in patients with metastatic breast cancer. Ann Oncol 13: 910–918, 2002

    Article  PubMed  Google Scholar 

  28. Gogas H, Papadimitriou C, Kalofonos HP, Bafaloukos D, Fountizilas G, Tsavdaridis D, Anagnostopoulos A, Onyenadum A, Papakostas P, Economopoulos T, Christodoulou C, Kosmidis P, Markopoullos C: Neoadjuvant chemotherapy with a combination of pegylated liposomal doxorubicin (Caelyx) and paclitaxel in locally advanced breast cancer: a phase II study by the Hellenic Cooperative Oncology Group. Ann Oncol 13: 1737–1742, 2002

    Article  PubMed  Google Scholar 

  29. Sparano JA, Malik U, Rajdev L, Sarta C, Hopkins U, Wolff AC: Phase I trial of pegylated liposomal doxorubicin and docetaxel in advanced breast cancer. J Clin Oncol 19: 3117–3125, 2001

    PubMed  Google Scholar 

  30. Nagore E, Insa A and Sanmartin O. Antineoplastic therapy–induced palmar plantar erythrodysesthesia (Hand–Foot) syndrome. Am J Clin Dermatol 1: 225–234, 2000

    PubMed  Google Scholar 

  31. Sparano JA, O'Neill A, Schaefer PL, Falkson CI, Wood WC: Phase II trial of doxorubicin and docetaxel plus granulocyte–colony stimulating factor in metastatic breast cancer: an Eastern Cooperative Oncology Group Study E1196. J Clin Oncol 18: 2369–2377, 2000

    PubMed  Google Scholar 

  32. Holmes F, Blum JL, Kruger S, Ratnam S, Liu L, Boehm KA, Asmar L, O'Shaughnessy JA: Breast Cancer Res and Treat 82: 537 [abstr], 2003

    Google Scholar 

  33. Bischoff J, Hesse S, Stemmler H, Zauner S, Gutschow K: A Phase I study of PEG liposomal doxorubicin (PLD) plus docetaxel (D) in metastatic breast cancer (MBC). Proc Am Soc Clin Oncol 282 [abstr], 2003.

  34. Slamon DJ, Leyland–Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L: Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpressed HER2. N Engl J Med 344: 783–792, 2001

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morabito, A., Gattuso, D., Stani, S.C. et al. Safety and Activity of the Combination of Pegylated Liposomal Doxorubicin and Weekly Docetaxel in Advanced Breast Cancer. Breast Cancer Res Treat 86, 249–258 (2004). https://doi.org/10.1023/B:BREA.0000036898.45123.e9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:BREA.0000036898.45123.e9

Navigation