The first was a Phase I/II study by Theodoulou et al. [55] that included 37 patients with HER2-positive metastatic breast cancer, 14 patients had been previously treated with adjuvant doxorubicin (<240mg/m2) and 17 patients with one or two lines of prior chemotherapy for advanced disease (11 with trastuzumab). Myocet 60mg/m2 was administered every 3 weeks plus trastuzumab Inhibitors,research,lifescience,medical 2mg/Kg weekly. Response rate was 58% (95%

CI 41–75%). A LVEF reduction of >10% was observed in 10 patients (25%). Five patients (12%) presented with a LVEF < 50%, 4 of them had been pretreated with anthracyclines; 2 patients (5%) withdrew from the trial due to cardiac toxicity. Another Phase I/II trial [56] included 69 patients with locally advanced or metastatic disease who had received no prior treatment. The treatment regimen chosen for the Phase II Inhibitors,research,lifescience,medical was trastuzumab combined with liposomal doxorubicin 50mg/m2 every 21 days and paclitaxel

80mg/m2 weekly. Response rate was 98.1% (95% CI 90.1–99.9). Median time to progression was 22.1 months (95% Inhibitors,research,lifescience,medical CI 16.4–46.3) in metastatic patients and had not yet reached in locally advanced patients by the time of publication. No cases of treatment-related clinical heart failure were observed. Twelve patients presented with an asymptomatic reduced LVEF, 8 of them recovering up to values of 50% or greater within a mean of 9 weeks. Venturini et al. [57] conducted a Phase II study in 31 patients with

first-line metastatic disease to evaluate the safety and efficacy of combining trastuzumab, LD, and docetaxel. Eight cycles of chemotherapy were administered, followed by trastuzumab monotherapy to trans-isomer price complete 52 weeks of treatment. The response Inhibitors,research,lifescience,medical rate was 65.5% with a TTP of 13 months. Five of the 31 patients experienced a ≥ 20% reduction from baseline or an absolute LVEF < 45%. Another Phase I-II trial with LD in combination with trastuzumab and docetaxel was conducted by Amadori et al. [58]. Forty-five patients with Inhibitors,research,lifescience,medical metastatic breast cancer received weekly trastuzumab associated with LD 50mg/m2 every 3 weeks and docetaxel 30mg/m2 on days 2 and 9. The response rate was 55.6% with a TTP of 10.9 months. Only 2 patients had a decrease in almost LVEF below 50%. Similarly, the use of PLD combined with trastuzumab may reduce the incidence of cardiotoxicity while maintaining a similar efficacy. We shall describe a series of small Phase II studies that investigated this alternative. Chia et al. [59] included 30 patients with HER2-positive metastatic breast cancer (MBC), 13 of them previously treated with adjuvant anthracyclines (<300mg/m2). PLD 50mg/m2 was given every 4 weeks and trastuzumab 2mg/Kg weekly for 6 cycles. Response rate was 52% and PFS 12 months. The most frequent toxicities were grade 3 hand-foot syndrome (30%) and grade 3/4 neutropenia (27%). Cardiac toxicity incidence was 10% and in no case was symptomatic. Andreopoulou et al.