Metronomic vinorelbine is an excellent and safe treatment for advanced breast cancer: a retrospective, observational study

Abstract

Advanced breast cancer (ABC) has become a chronic disease. In such a situation, an effective therapy with low toxicities and economically acceptable is needed. Metronomic vinorelbine (mVNR) has been proved to be effective on the control of MBC. The aim of this study is to evaluate the efficacy and safety of mVNR as the salvage therapy for patients with ABC. Oral vinorelbine (VNR) was administered at 70 mg/m2, fractionated on days 1, 3, and 5, for 3 weeks on and 1 week off. Once the mVNR was combined with trastuzumab, or was combined with bevacizumab, the schedule was changed to 2 weeks on and 1 week off. Clinical data of patients with ABC who had received treatment with mVNR and tumor characteristics were collected and analyzed. From Mar. 2013 to Dec, 2020, there were 90 patients with ABC received mVNR. The overall response rate was 53.3% and overall disease control rate (DCR) was 78.9% in this study, including 4 (4.4%) cases reached complete response, 44 (48.9%) cases reached partial response and 23 (25.6%) cases were table disease. The median time to treatment failure (TTF) of the Lumina A patients was 13.3 months, Lumina B patients was 9.1 months, Her-2 enrich patients was 8.9 months, and triple negative breast cancer (TNBC) patients was 5.6 months. Median overall survival time for Lumina A, Lumina B, Her-2 enrich and TNBC were 54.6 months, 53.3 months, 59.5 months and 24.5 months separately. Side effects were minimal and manageable. Metronomic VNR can be an effective treatment for ABC either works as a switch maintenance or salvage therapy. In combination with target therapy or hormonal therapy, mVNR can further improve TTF and DCR with minimal toxicities. Further study should focus on the optimal dosage, schedule and combination regimen.

The inherent fragility of collective proliferative control

“…As shown in Fig. 6, the unique tendency of collective transitions to reverse themselves following removal of cells or appropriate changes to parameters provides both a model for cancer dormancy and an justification for the ability of metronomic chemotherapy to perform comparably to high-dose, short term treatments [29][30][31][32] .…”

“…Interestingly, whereas minimizing relapse with short term treatments requires fine-tuning treatment strength, it appears that low-intensity treatment over a long duration often does equally well. Although these results come from the exploration of a rather simplified, "toy" model, it is intriguing that they predict a phenomenon that has been observed in the clinic, which is that long-duration treatment of cancers with low dose chemotherapeutic agents (so called "metronomic therapy") sometimes achieves surprisingly good results [29][30][31][32] . Results in Fig.…”

Cost-effectiveness of sacituzumab govitecan versus chemotherapy in advanced or metastatic triple-negative breast cancer

“…Thirdly, the application of cure mode also resulted in uncertainty. As the prognosis of advanced or metastatic breast cancer is poor, the probability of cure state is little [ 30 ]. Although a small proportion of patients in the cohort may have a potentially curative condition, cure still belongs to an ideal state and the setting of cure mode was conducted for exploratory purposes only.…”

Anti-tumor effects of low-dose metronomic vinorelbine in combination with alpelisib in breast cancer cells

“…VRL, an orally available anti-microtubule agent, represents a standard treatment option in MBC (Aapro et al, 2019[ 1 ]; Huang et al, 2020[ 21 ]). In addition, VRL is one of the most commonly used agents for MCT with proven efficacy and excellent safety profile (Cazzaniga et al, 2019[ 13 ]; Liu et al, 2021[ 28 ]). Based on the growing body of evidence, MCT can be considered as a suitable treatment option in selected MBC patients.…”