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Lorusso V, Giotta F, Bordonaro R, Maiello E, Del Prete S, Gebbia V, Filippelli G, Pisconti S, Cinieri S, Romito S, Riccardi F, Forcignanò R, Ciccarese M, Petrucelli L, Saracino V, Lupo LI, Gambino A, Leo S, Colucci G. Non-pegylated liposome-encapsulated doxorubicin citrate plus cyclophosphamide or vinorelbine in metastatic breast cancer not previously treated with chemotherapy:a multicenter phase III study. Int J Oncol 2014; 45:2137-42. [PMID: 25176223 DOI: 10.3892/ijo.2014.2604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/20/2014] [Indexed: 11/05/2022] Open
Abstract
We conducted a phase III multicenter randomized trial to compare the efficacy of the combination of liposome encapsulated doxorubicin (Myocet(©)) plus either cyclophosphamide (MC) or vinorelbine (MV). Since July 2006, 233 patients affected with metastatic breast cancer were randomized to receive the combination of Myocet (M) 60 mg/m(2) i.v. plus cyclophosphamide (C) 600 mg/m2 on Day 1 of a 21‑day cycle (Arm A) or Myocet (M) at 50 mg/m2 plus vinorelbine (V) 25 mg/m2 i.v. on Day 1 and V 60 mg/m2 orally on Day 8 on a 21‑day cycle (Arm B). The primary endpoints of the study was time to progression (TTP); secondary endpoints were RR, toxicity and OS. Response was observed in 53/116 (45.7%) evaluable patients of Arm A vs. 51/112 (45.5%) of Arm B, respectively (P=NS). Median TTP was 41 weeks (95% CI, 32‑51) and 34 weeks (95% CI, 26‑39), for M/C and M/V, respectively (P=0.0234). The difference in median OS was not statistically significant (131 vs. 122 weeks; P=0.107). With regard to toxicity, patients treated with MV showed a slight increase of neutropenia and constipation, as compared to those treated with MC. No clinical signs of cardiotoxicity were observed. The MC combination remains as an unbeaten 'standard' in first line treatment of MBC.
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Affiliation(s)
- V Lorusso
- National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - F Giotta
- National Cancer Research Center, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - E Maiello
- Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo (FG), Italy
| | - S Del Prete
- Frattamaggiore Hospital, Frattamaggiore (NA), Italy
| | - V Gebbia
- La Maddalena Hospital, Palermo, Italy
| | | | | | - S Cinieri
- Brindisi Medical Oncology Department and Breast Unit e Medical Department, European Insitute of Oncology, Milan, Italy
| | - S Romito
- Ospedali Riuniti Hospital, Foggia, Italy
| | | | | | | | | | | | - L I Lupo
- Vito Fazzi Hospital, Lecce, Italy
| | | | - S Leo
- Vito Fazzi Hospital, Lecce, Italy
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Chan A, Verrill M. Capecitabine and vinorelbine in metastatic breast cancer. Eur J Cancer 2009; 45:2253-65. [DOI: 10.1016/j.ejca.2009.04.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 04/21/2009] [Accepted: 04/24/2009] [Indexed: 10/20/2022]
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Ardavanis A, Mavroudis D, Kalbakis K, Malamos N, Syrigos K, Vamvakas L, Kotsakis A, Kentepozidis N, Kouroussis C, Agelaki S, Georgoulias V. Pegylated liposomal doxorubicin in combination with vinorelbine as salvage treatment in pretreated patients with advanced breast cancer: a multicentre phase II study. Cancer Chemother Pharmacol 2006; 58:742-8. [PMID: 16718470 DOI: 10.1007/s00280-006-0236-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 03/08/2006] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the activity and tolerance of pegylated liposomal doxorubicin in combination with vinorelbine in pretreated patients with metastatic breast cancer. PATIENTS AND TREATMENT Thirty-six women with metastatic breast cancer were enrolled. The median age was 64 years, 80% of the patients had a performance status of 0-1, 30 (83%) had visceral disease and 83% had received prior taxanes while 50% anthracyclines. Treatment consisted of pegylated liposomal doxorubicin (40 mg/m2 on day 1) and vinorelbine (25 mg/m2 on days 1 and 15) every 4 weeks. RESULTS In an intention-to-treat analysis 2 (6%) complete and 12 (33%) partial responses were observed (overall response rate 39%; 95% CI: 23-54.8%); 8 (22%) and 14 (39%) patients experienced stable and progressive disease, respectively. The median TTP was 6.5 months and the median survival time 14.2 months. The 1-year survival rate was 54.1%. Grade 3 and 4 neutropenia occurred in 21 (58%) patients, grade 3-4 anemia in four (11%) and grade 4 thrombocytopenia in one (3%). Two (6%) patients developed febrile neutropenia. Non-hematologic toxicity was mild and easily manageable. There was no clinically important cardiac toxicity or treatment-related deaths. CONCLUSIONS The combination of pegylated liposomal doxorubicin and vinorelbine is an active and well tolerated salvage regimen in patients with metastatic breast cancer which merits further evaluation.
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Affiliation(s)
- Alexandros Ardavanis
- Department of Medical Oncology, University General Hospital of Heraklion, PO BOX 1352, 71110, Heraklion, Crete, Greece
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Mano M. Vinorelbine in the management of breast cancer: New perspectives, revived role in the era of targeted therapy. Cancer Treat Rev 2006; 32:106-18. [PMID: 16473470 DOI: 10.1016/j.ctrv.2005.12.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Accepted: 12/20/2005] [Indexed: 10/25/2022]
Abstract
Vinorelbine is a semi-synthetic vinca alkaloid that has been shown active in many tumour types and is currently registered for the treatment of advanced breast cancer (ABC) and non-small cell lung cancer (NSCLC). This agent has a generally favourable safety profile, and may be suitable for use in special populations such as the elderly and/or frail patient. However, with the taxanes firmly established as standard second line treatment for ABC after failure of an anthracycline, vinorelbine has been generally relegated for use as third line therapy, in competition with the oral compound capecitabine. More recently, the exciting results observed with the combination of vinorelbine and trastuzumab in patients with Her-2 overexpressing/amplified tumours, as well as the development of a reliable formulation and revised schedule of oral vinorelbine with proven activity in ABC appear to have revived the interest in this compound in the management of this disease. There are still a number of unanswered questions that will have to be addressed by properly designed, adequately powered randomised clinical trials.
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Affiliation(s)
- Max Mano
- Institut Jules Bordet, Rue Héger-Bordet 01, 1000 Bruxelles, Belgium.
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Ludwig C, Stoelben E, Hasse J. Disease-free survival after resection of lung metastases in patients with breast cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2003; 29:532-5. [PMID: 12875861 DOI: 10.1016/s0748-7983(03)00074-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS Metastatic breast cancer is a systemic disease. The discussion concerning the resection of lung metastases in patients with breast cancer is controversial. METHODS Retrospective analysis of 25 patients with suspected pulmonary metastases operated between March 1989 and September 1998. Survival probabilities and disease-free survival was analysed using the Kaplan-Meier method and the log-rank test. RESULTS The median survival rate after resection of lung metastases for the 21 patients was 96.9 months. The disease-free survival (DFS) after resection of lung metastases was 27.6 months. Survival was not influenced by the receptor status, lymph node involvement, number of lung metastases (p=0.8) or the disease-free interval (DFI) (0.59). DFS was, however, influenced by the DFI. With a DFI of <2 years survival was 8.5 months, whereas with a DFI >2 years it was 36.1 months (p=0.012). The DFS was influenced, but not statistically significant, by the number of lung metastases (n=1/n>1). The median DFS was 28.8 months with one metastasis and 13.1 months with multiple metastases (p=0.29). CONCLUSIONS The indication to remove solitary lung metastases in patients with previous breast cancer is supported by these findings. Especially when the disease-free interval is greater than two years.
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Affiliation(s)
- C Ludwig
- Division of Thoracic Surgery, University Hospital, Freiburg, Germany.
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