Impressive objective response to nab-paclitaxel plus trastuzumab as fifth line therapy in aelderly HER2-positive breast cancer patient

Maria Rosaria Valerio¹, Chiara Ancona², Antonella Marchese², Calogero Cipolla³, Giuseppa Graceffa³, Vittorio Gebbia²

¹Medical Oncology Unit, Department of Oncology, University of Palermo, Policlinico P. Giaccone, Via del Vespro n. 90110 Palermo, Italy  - ²MedicalOncology Unit, La Maddalena Clinic for Cancer, University of Palermo, DiBiMis, via San Lorenzo Colli n. 312d, 90110 Palermo, Italy - ³Surgical Oncology, Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy

Agent targeting HER-2 pathway plus chemotherapy has represented a major progress in the management of patients with breast cancer. However the role of late-line treatment in heavily pretreated patients is largely unclear. In the last decade nab-paclitaxel has show significant activity and good toxicity profile in metastatic breast cancer.  We report the case of a 76-year-old Caucasian woman with metastatic HER-2 positive ductal infiltrating breast carcinoma treated with a combination of weekly nab-paclitaxel and trastuzumab as fifth-line therapy.  She had previously received first-line paclitaxel and trastuzumab, second-line vinorelbine and trastuzumab, third-line TDM1 and fourth-line oral capecitabine and lapatinib. Clinical and radiological staging showed progression at bone, skin and soft-tissue. The patients received weekly nab-paclitaxel plus trastuzumab. Massive objective response was clinically and PET documented which lasted 8 months. Tolerance to treatment was fairly good as well as cardiac safety. To the best of our knowledge, this is the first reported case of efficacy of nab-paclitaxel in combination with trastuzumab as fifth-line of treatment in a patient with metastatic HER-2 positive breast cancer.