Phase II study of paclitaxel in patients with metastatic breast carcinoma refractory to standard chemotherapy

BACKGROUND The authors conducted a single institution Phase II clinical trial to determine whether paclitaxel had antitumor activity in patients with metastatic breast carcinoma that was refractory to standard chemotherapy. METHODS Patients with metastatic breast carcinoma were eligible for the study if they had disease progression after at least 2 prior chemotherapy regimens. Patients who had received three prior regimens were treated in a separate cohort. All patients were required to have received doxorubicin in the past and were not eligible if they had received prior therapy with paclitaxel. The starting dose of paclitaxel for low risk patients was 175 mg/m2, administered as a 24-hour continuous infusion; the starting dose of paclitaxel was 150 mg/m2 for patients who had received ≥ 3 prior regimens. Therapy was given every 3 weeks and continued for at least 2 courses unless there was evidence of rapidly progressing disease, for at least 3 courses if there was no change in disease and Grade 3 or 4 (based on National Cancer Institute toxicity criteria) toxicity was not noted, and for 6 courses beyond the maximum response in patients who demonstrated complete or partial responses and showed no evidence of disease progression. RESULTS Sixty-eight of 69 patients entered in the study were evaluable for response: 35 patients who had received 2 prior chemotherapy regimens for Stage IV disease and 33 patients who had received ≥ 3 prior regimens. A partial response was observed in 7 patients who had received 2 prior regimens, for an objective response rate of 20% (95% confidence interval [95% CI], 14–26%). In the group who had received ≥ 3 prior regimens, a total of 6 partial responses were observed, for an objective response rate of 18% (95% CI, 12–23%). The median response duration was 8.2 months (range, 2.7–10.1 months) for the group who had received 2 prior regimens and 5.8 months (range, 2.1–9.5 months) for patients who received ≥ 3 prior regimens. Responses were noted in patients with anthracycline-resistant tumors. CONCLUSIONS Paclitaxel was active in heavily pretreated patients with metastatic breast carcinoma, including anthracycline-resistant breast carcinoma. Cancer 2000;89:2195–201. © 2000 American Cancer Society.