Strategies for delaying or treating resistance to herceptin (in cell lines only)

1: Clin Cancer Res. 2006 Feb 1;12(3):904-16. Related Articles, Links

Strategies for Delaying or Treating In vivo Acquired Resistance to Trastuzumab in Human Breast Cancer Xenografts.

du Manoir JM, Francia G, Man S, Mossoba M, Medin JA, Viloria-Petit A, Hicklin DJ, Emmenegger U, Kerbel RS.

Authors' Affiliations: Molecular and Cellular Biology Research, Sunnybrook and Women's College Health Sciences Centre.

PURPOSE: Acquired resistance to trastuzumab (Herceptin) is common in patients whose breast cancers show an initial response to the drug. The basis of this acquired resistance is unknown, hampering strategies to delay or treat such acquired resistance, due in part to the relative lack of appropriate in vivo tumorigenic models.EXPERIMENTAL DESIGN: We derived an erbB-2-positive variant called 231-H2N, obtained by gene transfection from the highly tumorigenic erbB-2/HER2-negative human breast cancer cell line, MDA-MB-231. Unlike MDA-MB-231, the 231-H2N variants was sensitive to trastuzumab both in vitro and especially in vivo, thus allowing selection of variant resistant to drug treatment in the latter situation after showing an initial response.RESULTS: The growth of established orthotopic tumors in severe combined immunodeficient mice was blocked for 1 month by trastuzumab, after which rapid growth resumed. These relapsing tumors were found to maintain resistance to trastuzumab, both in vitro and in vivo. We evaluated various therapeutic strategies for two purposes: (a) to delay such tumor relapses or (b) to treat acquired trastuzumab resistance once it has occurred. With respect to the former, a daily oral low-dose metronomic cyclophosphamide regimen was found to be particularly effective. With respect to the latter, an anti-epidermal growth factor receptor antibody (cetuximab) was effective as was the anti-vascular endothelial growth factor (anti-VEGF) antibody bevacizumab, which was likely related to elevated levels of VEGF detected in trastuzumab-resistant tumors.CONCLUSIONS: Our results provide a possible additional rationale for combined biological therapy using drugs that target both erbB-2/HER2 and VEGF and also suggest the potential value of combining less toxic metronomic chemotherapy regimens not only with targeted antiangiogenic agents but also with other types of drug such as trastuzumab.

PMID: 16467105 [PubMed - in process]
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what they are referring to as "metronomic chemotherapy" is the daily oral use of very very low doses of chemotherapy. Unlike weekly or every three week doses of high doses of chemotherapy which causes a lot of toxicity in normal cells and allows time for the patient to recovery during which the cancer cells develop ways to become resistant to the chemotherapy, very low doses given very often (daily) kill the weakest link in the chain, the endothelial cell of the new blood vessels the tumor recruits. This chokes off the blood supply to the tumor. At least two of the authors above have written a lot about it--so try plugging them into Google or Pubmed if you are interested