Low-Dose Metronomic Oral Administration of Vinorelbine in the First-line Treatment of Elderly Patients With Metastatic Breast Cancer

Addeo, Raffaele; Sgambato, Alessandro; Cennamo, Gregorio; Montella, Liliana; Faiola, Vincenzo; Abbruzzese, Alberto; Capasso, Elena; Leo, Luigi; Botti, Gerardo; Caraglia, Michele; Prete, Salvatore Del

doi:10.3816/cbc.2010.n.039

Cited by 86 publications

(40 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The overall response rate (ORR), primary endpoint of this study, was 38%, with 6% and 32% of complete (CR) and partial response (PR), respectively. Disease control was 68%, with 7.7 months of median progression free survival (PFS) and 15.9 months of median overall survival (OS) [67]. Recently, a group of Italian clinicians reported the results of a phase I-II study evaluating the use of vinorelbine with a metronomic schedule combined with capecitabine in patients with metastatic breast cancer previously treated with anthracyclines and taxanes.…”

Section: Breast Cancermentioning

confidence: 97%

Metronomic chemotherapy from rationale to clinical studies: A dream or reality?

Gaspar

Silvestris

Licchetta

et al. 2015

Critical Reviews in Oncology/Hematology

View full text Add to dashboard Cite

Section: Breast Cancermentioning

confidence: 97%

Metronomic chemotherapy from rationale to clinical studies: A dream or reality?

Gaspar

Silvestris

Licchetta

et al. 2015

Critical Reviews in Oncology/Hematology

View full text Add to dashboard Cite

“…[87][88][89] Oral vinorelbine at 70 mg/m 2 , on days 1, 3, and 5, for 3 weeks on and 1 week off, every 4 weeks was assessed in 34 elderly patients with metastatic breast cancer (median age 74 years). 90 The ORR in 13 patients was 38%, and median PFS and overall survival were 7.7 months (95% CI 6.9-9.05 months) and 15.9 months (95% CI 13.1-15.91 months), respectively.…”

Section: Metronomics In the Metastatic Settingmentioning

confidence: 99%

“…Metronomic oral vinorelbine was investigated in at least two phase II trials. 90,143 The first trial included 34 elderly patients with metastatic breast cancer (median age 74 years, range 70-84 years) who received oral vinorelbine at 70 mg/m 2 , fractionated on days 1, 3, and 5, for 3 weeks on and 1 week off, every 4 weeks, for a maximum of 12 cycles. Two patients (6%) achieved complete responses and 11 (32%) achieved partial responses.…”

Section: Metronomics In the Metastatic Settingmentioning

confidence: 99%

“…Median progression-free survival and median overall survival were 7.7 months (95% CI 6.9-9.05 months) and 15.9 months (95% CI 13.1-15.91 months) for all patients. 90 The second trial included 32 patients with advanced-stage breast cancer (median age 76 years, range 69-83 years) treated with oral vinorelbine 30 mg total dose, 1 day on and 1 day off, until disease progression or unacceptable toxicity. No grade 3 and 4 adverse events were reported.…”

Section: Metronomics In the Metastatic Settingmentioning

confidence: 99%

See 1 more Smart Citation

Clinical overview of metronomic chemotherapy in breast cancer

2015

View full text Add to dashboard Cite

Over 15 years ago, low-dose metronomic chemotherapy was shown to induce disease control in patients with advanced-stage breast cancer with a lower incidence of adverse events compared with conventional maximum tolerated dose chemotherapy. Good response rates have been seen in heavily pre-treated patients for whom limited treatment options are available. Most patients prefer oral therapy and metronomic chemotherapy is a convenient alternative in patients with advanced-stage disease in which minimal toxicity and good tumour control are the overall aims of treatment. The addition of metronomic protocols to standard neoadjuvant chemotherapy regimens has produced promising pathological complete response rates. Ongoing trials including the SYSUCC-001 trial in patients with triple-negative breast cancer and the IBCSG 22-00 trial that is assessing a cyclophosphamide-methotrexate maintenance regimen after standard adjuvant therapy in hormone receptor-negative disease, will clarify the value of adding this approach to conventional therapies. The low cost associated with metronomic chemotherapy represents an opportunity for the utilization of this treatment option, especially in developing countries, and poses a challenge for the launch of large trials sponsored by industry. Using breast cancer as the principal example, we discuss the key clinical advances in this area, including new trial design, appropriate patient and end point selection, as well as the evolving rationale for metronomic chemotherapy combinations.

show abstract

“…Tolerability was excellent with little side effects. Oral vinorelbine was also tested in a metronomic schedule for the first-line treatment of elderly patients with metastatic breast cancer [36]. In this study, 34 patients (median age 74 years) were treated with oral vinorelbine at 70 mg/m 2 , fractionated on days 1, 3, and 5, 3 weeks on/1 week off, every 4 weeks.…”

Section: Metronomic Schedulesmentioning

confidence: 99%

Dose-Dense Chemotherapy in Metastatic Breast Cancer: Shortening the Time Interval for a Better Therapeutic Index

Schmidt¹

2015

Breast Care

View full text Add to dashboard Cite

factor receptor 2 (HER2)-positive advanced breast cancer. Still, despite these advances in targeted therapies, cytotoxic chemotherapy remains a cornerstone in the treatment of advanced disease.Clearly, chemotherapy has an essential role in rapidly progressive life-threatening disease. In these situations, it is sometimes prudent to sacrifice toxicity for improved efficacy leading to rapid responses which in turn should improve the quality of life of the patient.This goal can be achieved by combining chemotherapy with targeted agents like bevacicumab [2] and trastuzumab [3]. Another possibility to achieve a fast response is to combine several chemotherapeutic agents. Even though this approach does not lead to improved survival compared to sequential single-agent chemotherapy, it is sometimes necessary for prompt symptom control. In a meta-analysis of 12 trials with 2,317 patients randomized to combination chemotherapy compared to the same drugs used sequentially, the authors showed that combination chemotherapy led to a higher risk ratio (RR) of 1.13 (95% confidence interval (CI) 1.03-1.24; p = 0.008) at the cost of a higher rate of febrile neutropenia (RR 1.32, 95% CI 1.06-1.65; p = 0.01). Despite the higher response rate, there was no difference in overall survival (OS) between these treatment strategies (hazard ratio (HR) 1.04, 95% CI 0.93-1.16; p = 0.45). Furthermore, combination chemotherapy led to a higher risk of progression (HR 1.16, 95% CI 1.03-1.31; p = 0.01). This high-level evidence further supports the recommendations to use sequential monotherapy unless there is rapid disease progression [4].However, it is in this very situation that the concept of dose density can come into play, including in advanced and metastatic breast cancer. Dose-Dense ChemotherapyIn an attempt to increase the efficacy of anthracycline-and taxane-containing regimens originally used in the adjuvant treatment Keywords Dose-dense · Metastatic · Breast cancer · Weekly · Metronomic Summary Despite the advancement of targeted therapies in metastatic breast cancer, chemotherapy is still of pivotal importance. The concept of dose density is known to increase the efficacy of chemotherapy. In metastatic disease, preservation of the quality of life is equally important. Because of this, weekly regimens are a cornerstone in metastatic disease. Taxanes like paclitaxel or nab-paclitaxel as well as antracyclines are often used in palliative treatment. Further advances to increase dose density have led to the concept of daily metronomic schedules with oral chemotherapeutic drugs like cyclophosphamide, capecitabine, or vinorelbine. Metronomic chemotherapy affects tumor angiogenesis and also weakens immunosuppressive regulatory T cells, promoting better control of tumor progression. Weekly or daily dose-dense regimens are a reasonable compromise between efficacy and toxicity to improve the therapeutic index. This is most important for the treatment of chronic disease where palliation and preservation of quality of life are vital.

show abstract

Low-Dose Metronomic Oral Administration of Vinorelbine in the First-line Treatment of Elderly Patients With Metastatic Breast Cancer

Cited by 86 publications

References 26 publications

Metronomic chemotherapy from rationale to clinical studies: A dream or reality?

Metronomic chemotherapy from rationale to clinical studies: A dream or reality?

Clinical overview of metronomic chemotherapy in breast cancer

Dose-Dense Chemotherapy in Metastatic Breast Cancer: Shortening the Time Interval for a Better Therapeutic Index

Contact Info

Product

Resources

About