An immunotherapeutic approach to treatment of breast cancer: focus on trastuzumab plus paclitaxel

Recent emphasis has focused on the development of an immunotherapeutic appr oach toward the treatment of breast cancer. In particular, evaluation of an tibodies and vaccines are active areas of research. The monoclonal antibody trastuzurnab (H), directed against the HER-2/neu protein, has resulted in inhibition of tumor growth in both preclinical and clinical studies. This e ffect can be increased when used in combination with several chemotherapeut ic agents. A randomized trial of chemotherapy alone versus chemotherapy plu s H in untreated metastatic breast cancer patients found prolonged survival in the combination therapy arm. Cardiac toxicity was increased with doxoru bicin and cyclophosphamide plus H but not for paclitaxel (T) plus H. Severa l trials of dose-dense weekly T have found minimal toxicity and significant clinical benefit. These findings prompted the initiation of a trial to eva luate weekly 1-h T plus weekly H. preliminary data from this ongoing study demonstrate few side effects and a response rate of 64% (95% CI 42-76%). Th e optimal role of H in the treatment of breast cancer has not yet been defi ned, Additional evaluation in the metastatic and adjuvant settings is plann ed.