Review Article

Combination Drug Delivery Approaches in Metastatic Breast Cancer

Table 2

Clinically used combination regimens of target specific biologic agent(s) in metastatic breast cancer.

ClassesRegimensAdvantagesDisadvantagesReferences

Trastuzumab + Doxorubicin + CyclophosphamideImproved RR, PFS, and OSCardiomyopathy, hematologic toxicity[41, 42]
Trastuzumab + Epirubicin + Cyclophosphamide
mAb basedTrastuzumab + other chemotherapy (Paclitaxel, Docetaxel, Vinorelbine, Capecitabine, Platinum compounds, and Gemcitabine)Improved RR and PFSIncreased hematologic toxicity[43]
Bevacizumab + PaclitaxelImproved PFSMore toxicity (hypertension, proteinuria, bleeding, nasal septum perforation, thromboembolic event, heart failure, mortality)[44]
Cetuximab + CisplatinImproved RR and PFS in patients with TNBCMore acne-like rash, neutropenia, dyspnea[38]

Lapatinib + Capecitabine
Lapatinib + PaclitaxelImproved RR, TTP, PFSMore toxicity (toxicity from chemotherapy plus diarrhea, skin rash, nausea, pruritis)[45ā€“47]
Tyrosine kinase inhibitor basedLapatinib + Letrozole
Sunitinib + DocetaxelNo worsen toxicityNonsignificant combination activity[48]
Erotinib + Cisplatin + GemcitabineWell toleratedNo survival benefit[49]

PARP inhibitor basedIniparib + Gemcitabine + CarboplatinImproved PFS and OSNeutropenia, thrombocytopenia, anemia, fatigue or asthenia, leukopenia[50]
Olaparib + Gemcitabine + CarboplatinImproved RR[51]

Multiple targetedTrastuzumab + LapatinibImproved PFS and Overcome TRZ resistanceAdditive toxicity from TRZ and Lapatinib, patient compliance issue (IV and oral administration)[52]

OS: overall survival; PFS: progression-free survival; RFS: relapse-free survival; RR: response rate; TTP: time to progression; TRZ: trastuzumab.