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this type of cancer and was FDA approved for adjuvant use in November 2006. Trastuzumab is generally well tolerated, but patients treated with this drug do require regular cardiac monitoring. Unfortunately, some patients with this type of breast cancer will eventually develop resistance to trastuzumab, and for this reason, additional therapies directed at the HER2/neu signaling pathway are necessary. Lapatinib is an orally active tyrosine kinase inhibitor that interrupts the HER2/neu receptor signaling path- way and has demonstrated a significant improvement in overall survival when added to chemotherapy. In the United States, lapatinib is approved for use in combination with capecitabine for second-line treatment after trastuzumab. In clinical trials, lapa- tinib/capecitabine resulted in a statistically significant improvement in median overall survival compared to capecitabine alone. The main toxicities of lapatinib are diar- rhea, rash, nausea and itching, and possibly congestive heart failure, interstitial lung disease and hepatotoxicity. Pertuzumab, another recombinant humanized monoclonal antibody, also inhibits the intracellular signaling pathway and was FDA approved in June 2012 for use in women who experience their first recur- rence of breast cancer. It appears that the HER2/neu receptor is quite large and may have different sites that trastuzumab alone does not inhibit. The inhibition resulting from the use of both pertuzumab and trastuzumab allows for a more complete blockade of the HER2/neu receptor. Recent studies have shown statistical and clinical improvements in progression-free and overall survival when used in combination with docetaxel in women with recurrent breast cancer. Trastuzumab emtansine (T-DM1), an antibody-drug conjugate, is another HER2/neu-directed therapy option that is currently pending FDA approval. T-DM1 is trastuzumab linked to the chemo- therapeutic agent maytansine, allowing the maytansine preferential delivery to the tumor cells via the tumor-specific overexpression of HER2/neu. The result is increased delivery of maytansine to the tumor and reduced effects on normal tissues. Early clinical trials suggest it is an active agent in patients with heavily pretreated HER2/neu overexpressing metastatic breast cancer. In the EMILIA clinical trial, 978 patients with HER2/neu-positive breast cancer previously treated with trastu- zumab and a taxane were randomly assigned to treatment with T-DM1 or the combination of capecitabine plus lapatinib. Compared to capecitabine/ lapatinib, T-DM1 resulted in decreased risk of disease progression and longer overall survival, as well as a clinically significant improvement in the overall response rate with fewer serious toxicities in the T-DM1 group. Cancer Care Centers of South Texas conducts clinical trials in the San Antonio area through the US Oncology Research program. For more information, please see www.CancerCareSouthTexas.com. ■ If she gets hurt in her backyard, she'll need treatment just as close. Redefining healthcare downtown. Opening early 2013 Broken arms, sprained ankles, even allergies - complete care for kids where I-10 meets I-35. Our new Clinical Pavilion on the Robert B. Green Campus downtown opens in early 2013. Visit our website for a special invitation to our grand opening! UniversityHealthSystem.com/RBGC Accepting most forms of insurance, Medicaid, Medicare and CHIP. MDNEWS.COM ■ MD NEWS San Antonio | 17