Metronomic oral vinorelbine in a real-world population of advanced non-small cell lung cancer patients

Estevinho, F.; Gomes, Rita; Hasmucrai, Direndra; Barata, Fernando

doi:10.1016/j.pulmoe.2020.09.003

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…The potential of metronomic chemotherapy has been assessed in various advanced cancer in preclinical and clinical studies. 8 , 12 , 13 , 22 , 23 In metastatic breast cancer, metronomic chemotherapy with vinorelbine is a treatment option. 24 Despite the availability of immunotherapy or targeted therapy agents as first-line treatment in advanced NSCLC, there are still NSCLC patients with advanced disease who may not be eligible for these treatments.…”

Section: Discussionmentioning

confidence: 99%

Metronomic oral vinorelbine in previously untreated advanced non-small-cell lung cancer patients unfit for platinum-based chemotherapy: results of the randomized phase II Tempo Lung trial

et al. 2021

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Background To assess the efficacy and safety of a metronomic schedule of oral vinorelbine (mVNR) in advanced non-small-cell lung cancer (NSCLC) in patients unfit for platinum-based combination chemotherapy. Patients and methods This was a multicenter, prospective, randomized, open-label phase II study in treatment-naive patients with TNM stage IIIB/IV NSCLC. Patients received mVNR at a fixed dose of 50 mg × 3 or standard schedule 60-80 mg/m 2 weekly until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS) without grade 4 toxicity (G4PFS; NCI-CTC v4). Main secondary objectives were safety, disease control rate (DCR) without grade 4 toxicity (G4DCR), DCR, PFS, overall survival (OS) and quality of life (QoL). Results A total of 167 patients were included, 83 and 84 patients in the mVNR and standard arms, respectively. The median G4PFS was 4.0 months [95% confidence interval (CI): 2.6-4.3] and 2.2 months (95% CI: 1.5-2.9), hazard ration (HR) = 0.63 (95% CI: 0.45-0.88), P = 0.0068 in favor of metronomic arm; G4DCR was 45.8% and 26.8% in the mVNR and standard arms, respectively. Grade 3-4 treatment-related adverse events were less frequent in the mVNR arm (25.3% versus 54.4%) mainly owing to a reduction in all grades (15.7% versus 51.9%) and grade 3-4 neutropenia (10.8% versus 42%). PFS was 4.3 (95% CI: 3.3-5.1) and 3.9 months (95% CI: 2.8-5.2) in mVNR and standard arms, respectively. No difference in median OS was observed. QoL was comparable between arms. Conclusions Metronomic oral vinorelbine significantly prolonged median G4PFS in advanced NSCLC patients unfit for platinum combinations as first-line treatment. It was associated with a clear reduction in toxicity and may be considered as an important option in this challenging population.

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Section: Discussionmentioning

confidence: 99%

Metronomic oral vinorelbine in previously untreated advanced non-small-cell lung cancer patients unfit for platinum-based chemotherapy: results of the randomized phase II Tempo Lung trial

et al. 2021

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“…In this context, MCT might be used as an alternative therapeutic strategy for elderly and debilitated patients (Table 4 ) [ 37 ]. Indeed, a growing amount of data from preclinical and clinical research studies indicates that oral etoposide and vinorelbine administered in metronomic regimens may be the most promising therapeutic options for elderly patients who are ineligible for MTD therapies [ 37 , 48 , 49 ].…”

Section: Metronomic Chemotherapy In Elderly Non-small Cell Lung Cance...mentioning

confidence: 99%

“…Median PFS: 9 months Median OS: 12 months Evidence of disease progression in 36% of patients Not reported D’Ascanio et al [ 53 •] Advanced non-small cell lung cancer 293 Vinorelbine Median age 76 years (range 39–94), of which 71% ≥ 70 years The ORR: 18%, with 42 partial responses and 0 complete responses; DCR: 72%. ; 54% of patients manifested stable disease and 28% of patients manifested disease progression The 46% of patients experienced grade 1/2 toxicity, including 31.1% G1/2 fatigue, 30.7% G1/2 anemia, and 15.0% G1/2 nausea or vomiting 21% of patients reported grade 3/4 toxicity, 10.2% G3/4 neutropenia and 9.6% G3 fatigue; 33% of patients experienced no toxicity with mVNR Estevinho et al [ 48 ] …”

Section: Metronomic Chemotherapy In Elderly Non-small Cell Lung Cance...mentioning

confidence: 99%

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Metronomic Chemotherapy in Elderly Patients

Bandini,

Calabrò,

Banchi

et al. 2024

Curr Oncol Rep

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Purpose of Review This review describes the most relevant studies found in the scientific literature regarding metronomic chemotherapy (MCT) in the geriatric oncology population to support its use as a feasible treatment of care in the frail elderly patients. Recent Findings Recent years have seen a reevaluation of cancer chemotherapeutic drugs and MCT is an emerging schedule in phase II and III clinical trials. Summary Ageing is one of the risk factors for the development of cancer, the incidence of whom increases dramatically in people who live longer. To date, standard oncological protocols involve chemotherapeutic drugs in short cycles of therapy at the maximum tolerated dose (MTD). Although these therapeutic regimens may be successful, they can cause important adverse drug reactions, especially in elderly or frail patients. MCT is a different modality of delivery of chemotherapeutic drugs (frequent low dose for prolonged time) and it looks at the overcoming of the limitations and disadvantages of MTD, in particular the toxicity aspect. We reviewed the experience of clinicians who have used MCT in clinical trials enrolling elderly patients with different cancer types.

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“…Moreover, metronomic oral vinorelbine (mVNR) is regarded as a well-tolerated and effective therapeutic capable of achieving long-term disease control and stability in metastatic diseases 126 , 127 . When conventional chemotherapy is not feasible for elderly patients, the use of mVNR, which is less toxic, can serve as a rescue treatment, and an impressive CBR of 72% has been demonstrated in elderly patients with advanced NSCLC 128 . Similarly, Addeo et al observed good tolerability and promising results (with an objective response rate (ORR) of 38%) in a cohort of 34 patients with metastatic breast cancer (median age, 74 years) treated with the mVNR regimen (70 mg/m2, fractionated on days 1, 3, and 5, for 3 weeks on and 1 week off, every 4 weeks) 127 .…”

Section: Application Of Mct In Oncology Clinicsmentioning

confidence: 99%

Metronomic chemotherapy in cancer treatment: new wine in an old bottle

Wu,

Zhou,

Chen

et al. 2024

Theranostics

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Metronomic oral vinorelbine in a real-world population of advanced non-small cell lung cancer patients

Cited by 5 publications

References 32 publications

Metronomic oral vinorelbine in previously untreated advanced non-small-cell lung cancer patients unfit for platinum-based chemotherapy: results of the randomized phase II Tempo Lung trial

Metronomic oral vinorelbine in previously untreated advanced non-small-cell lung cancer patients unfit for platinum-based chemotherapy: results of the randomized phase II Tempo Lung trial

Metronomic Chemotherapy in Elderly Patients

Metronomic chemotherapy in cancer treatment: new wine in an old bottle

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